158 Where There Is No Doctor 2011
4. Severe diarrhea with blood, with fever. (Bacterial dysentery caused by Shigella)
♦ Give ciprofloxacin to adults, 500 mg. 2 times a day for 3 days (see p.
356). But pregnant women and children under 18 years old should not use
ciprofloxacin. (For children under 8 weeks old, seek medical help.) Shigella
is often resistant to ampicillin (p. 352) and cotrimoxazole (p. 357) but they
are still being used. If the first medicine you try does not bring improvement
within 2 days, try another or seek medical help. Women in the first 3 months
of pregnancy should not use cotrimoxazole (see p. 357). Azithromycin will
also work, and is safe during pregnancy and for children. For adults, give 500
mg. by mouth the first day, and 250 mg. once a day for 4 days. For children’s
doses, see a health worker.
5. Severe diarrhea with fever, usually no blood.
♦ Fever may be partly caused by dehydration. Give lots of Rehydration Drink
(p. 152). If the person is very ill and does not improve within 6 hours after
beginning Rehydration Drink, seek medical help.
♦ Check for signs of typhoid fever. If present, treat for typhoid (see p. 188).
♦ In areas where falciparum malaria is common, also treat persons with diarrhea
and fever for malaria (see p. 186), especially if they have an enlarged spleen.
6. Yellow, bad smelling diarrhea with bubbles or froth, without blood or mucus.
Often a lot of gas in the belly, and burps that taste bad, like sulfur.
♦ This may be caused by parasites called giardia (see p. 145) or perhaps
by malnutrition. In either case, plenty of liquid, nutritious food, and rest
are often the best treatment. Severe giardia infections can be treated with
metronidazole (p. 368). Quinacrine (Atabrine) is cheaper, but has worse side
effects (p. 369).
7. Chronic diarrhea (diarrhea that lasts a long time or keeps coming back).
♦ This can be in part caused by malnutrition, or by a chronic infection such as
that caused by amebas or giardia. See that the child eats more nutritious food
more times a day (p. 110). If the diarrhea still continues, seek medical help.
8. Diarrhea like rice water. (Cholera)
♦ ‘Rice water’ stools in very large quantities may be a sign of cholera. In
countries where this dangerous disease occurs, cholera often comes in
epidemics (striking many people at once) and is usually worse in older
children and adults. Severe dehydration can develop quickly, especially if
there is vomiting also. Treat the dehydration continuously (see p. 152), and
give doxycycline or tetracycline (p. 355) or erythromycin
for children (p. 354) only in severe cases.
Cholera should be reported to the health
authorities. Seek medical help.
A ‘cholera bed’ like this can be made for
persons with very severe diarrhea. Watch
how much liquid the person is losing
and be sure he drinks larger amounts of
Rehydration Drink. Give him the Drink
almost continuously, and have him drink
as much as he can.
sleeve made of
plastic sheet