Current Clinical Management Suggestions: Emergency Department Management of a Patient with Acute Diarrhea
Department Of Emergency Medicine, Akdeniz University Faculty Of Medicine
Keywords: Acute diarrhea, antibiotics; Hyoscine N-Butylbromide; loperamide; Saccharomyces boulardii.
Providing medical care based on the current available evidence is a practice which can improve the service quality and protect physicians from potential legal problems. In the present study, we aimed to determine the most suitable diagnostic and treatment modalities by reviewing the literature on the basis of current evidence in patients who present to the emergency department (ED) with acute diarrhea. Six clinical questions have been formulated before the literature review has been performed on this “Current Clinical Management Suggestions”. A literature review was conducted after the key words related to those clinical questions had been determined. The databases used to select the relevant articles were PubMed (since 1966), Cochrane Systematical Reviews and Cochrane Central Registered of Controlled Trials. The following findings were noted after the analyses:
1. Starting antibiotic therapy in patients presenting to the ED with acute diarrhea without considering the underlying cause: Recommendation Level B,
2. Starting loperamide together with antibiotics in patients presenting to the ED with acute diarrhea: Recommendation Level A,
3. Starting loperamide without initiating antibiotics in patients with acute diarrhea thought to be non-invasive: Recommendation Level B,
4. Reducing the diarrhetic time by using “Saccharomyces Boulardii” in acute diarrhea: Recommendation Level C,
5. Findings related to the existence of a positive culture in patients with acute diarrhea:
a. Fever: Recommendation Level A,
b. High CRP levels: Recommendation Level B,
c. Bloody stool: Recommendation Level C,
6. Reducing the intestinal colic by using ‘Hyoscine N-Butylbromide’ in patients with acute diarrhea: Recommendation Level C.