Algorithm for the Evaluation of Acute Diarrhea (< 7 days)
Are the following present?
1. Severe illness: T > 38.50C, abdominal pain, bloody diarrhea, > 6 stools/24 h, dehydration
2. Immunocompromised patient: AIDS, post-transplantation
3. Elderly patient (> 70 yrs)
Send stool for following:
1. Fecal leukocytes
2. Routine stool culture
3. C difficile assay, if recent hospitalization or antibiotics
4. Ova and parasite testing, if:
a. Diarrhea > 10 days
b. Travel to endemic region
c. Community water-borne outbreak
d. HIV infection or men who have sex with men
Consider empiric antibiotic therapy while awaiting culture, if:
1. Fecal leukocyte positive
2. Bloody diarrhea, fever, abdominal pain
3. Dehydration or > 8 stools/24 h
4. Immunocompromised
5. Hospitalization required
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