GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 261

The most important aspect of treatment for invasive bacterial gastroenteritis is prompt
correction of dehydration. Large amounts of fluids (such as those delineated in Table 19-1 )
should be administered. Intravenous fluids may be necessary for more severe cases. A
bland diet may be given if it can be tolerated.
A hot-water bottle or other source of warmth placed on the abdomen may reduce some
of the pain and tenderness. Drugs to stop the diarrhea are not recommended because they
tendtoproduceintestinalparalysis,whichpreventstheindividualfromtakingfluidsorally.
These agents also may make the fever and overall disability worse. However, many indi-
viduals take such medications.
These infections should be treated with antibacterial agents. Ciprofloxacin (Cipro®) is
the drug of choice; TMP-SMX is the second choice. (In Latin America, 25 percent of Shi-
gella are resistant to TMP-SMX.) The usual duration of therapy is one week. Rifaximin
should be avoided if the infection is considered invasive.
Although antimicrobial therapy frequently produces marked improvement in twenty-
four hours or less, it must be continued for at least five days—longer if symptoms persist.
Individuals with these infections require rest; most should be in bed. People who have
had bacillary dysentery frequently require seven to ten days to recover their strength after
symptoms have disappeared. Evacuation is desirable for people who are not on extended
expeditions.
Enterohemorrhagic E. Coli
Enterohemorrhagic E. coli , serotype 0157:H7, produces a severe invasive infection of
the colon that is often manifested by colitis, bloody diarrhea, and abdominal pain. Under-
cooked meat, particularly beef, is often the source of infection, which is sometimes com-
plicated by anemia, kidney failure, and impaired brain function. Fever, chills, and an ex-
tremely tender abdomen can mimic an acute surgical disorder such as appendicitis, espe-
cially since the colitis may predominantly involve the colon near the appendix. Nospecific
treatment is available, but antibiotics such as ciprofloxacin (Cipro®) should be used in a
wilderness environment. Seriously ill individuals require hospitalization in an institution
thatcanprovidesupportivetherapy.Antimotilitydrugsshouldbeavoidedbecausetheyag-
gravate the illness.
Cholera
Cholera, once a scourge throughout the world, is almost nonexistent where modern san-
itation and water purification methods are practiced. However, infections that claim many
lives are common in some areas of the world. A major outbreak recently killed thousands
in Peru, Ecuador, and Colombia. In Southeast Asian countries, monsoon rains wash fe-
ces that have collected on the ground and in the streets into streams and rivers and regu-