PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES
Upon completion of the chapter, the reader will be able to:
Describe the epidemiology and clinical presentation of commonly encountered gastrointestinal (GI) infections.
Summarize common risk factors associated with the development of a GI infection.
Given a patient with a GI infection, develop an individualized treatment plan.
Outline the impact of widespread antimicrobial resistance on current treatment recommendations for GI infections.
Discuss the effect of host immunosuppression on the risk of disease complications and treatment strategies associated with GI infections.
Educate patients on appropriate prevention measures of GI infections.
Describe the role of antimicrobial prophylaxis and/or vaccination for GI infections.
One of the primary concerns related to gastrointestinal (GI) infection, regardless of the cause, is dehydration, which is the second leading cause of worldwide morbidity and mortality.1 Dehydration is especially problematic for children younger than age 5; however, the highest rate of death in the United States occurs among the elderly.1 KEY CONCEPT Rehydration is the foundation of therapy for GI infections, and oral rehydration therapy (ORT) is usually preferred (Table 76–1).2 Single-dose oral ondansetron should be considered the first-line antiemetic in children who are dehydrated with significant vomiting.3 In nonimmunocompromised hospitalized pediatric patients, Lactobacillus supplementation may reduce the length of hospitalization.4
Table 76–1Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss |Favorite Table|Download (.pdf) Table 76–1Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss
|Variable ||Mild (3%–5%) ||Moderate (6%–9%) ||Severe (10% or More) |
|Blood pressure ||Normal ||Normal ||Normal to reduced |
|Quality of pulses ||Normal ||Normal to slightly decreased ||Moderately decreased |
|Heart rate ||Normal ||Increased ||Increased (bradycardia in severe cases) |
|Skin turgor ||Normal ||Decreased ||Decreased |
|Fontanelle ||Normal ||Sunken ||Sunken |
|Mucous membranes ||Slightly dry ||Dry ||Dry |
|Eyes ||Normal ||Sunken orbits/decreased tears ||Deeply sunken orbits/decreased tears |
|Extremities ||Warm, normal capillary refill ||Delayed capillary refill ||Cool, mottled |
|Mental status ||Normal ||Normal to listless ||Normal to lethargic to comatose |
|Urine output ||Slightly decreased ||< 1 mL/kg/hour ||< 1 mL/kg/hour |
|Thirst ||Slightly increased ||Moderately increased ||Very thirsty |
|Fluid replacement ||ORT 50 mL/kg over 2–4 hours ||ORT 100 mL/kg over 2–4 hours ||Lactated Ringer 40 mL/kg in 15–30 minutes, then 20–40 mL/kg if skin turgor, alertness, and pulse have not returned to normal or Lactated Ringer or normal saline 20 mL/kg, repeat if necessary, and then replace water and electrolyte deficits over 1–2 days, followed by ORT 100 mL/kg over 4 hours |
In the United States, each year 31 major pathogens cause about 9 million ...