🦠 Management of Acute Gastroenteritis (AGE) and Food Poisoning

Symptoms: Diarrhea ± Nausea/Vomiting ± FeverSetting: Primary Care / OPD / ER (non-toxic patients)

🔑 Clinical Principles

1. Assess hydration → Give ORS for mild to moderate dehydration
2. Identify red flags → Bloody stool, high-grade fever, toxic signs
3. Determine likely etiology
   • Viral: Most common in children, self-limiting
   • Bacterial: More common in food poisoning (undercooked meat, seafood, contaminated water)
   • Toxin-mediated: Abrupt onset of vomiting, short-lived (e.g., Staph aureus, Bacillus cereus)

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🧾 Symptom-Specific Management

🟢 1. Diarrhea

✅ Preferred: Diosmectite (Dehecta)

• Natural clay adsorbent
• Binds bacterial toxins, viruses, and inflammatory mediators
• Shortens diarrhea without affecting motility
• Safe for all ages, no systemic absorption
• Especially good for children and viral diarrhea

⚠️ Use with Caution: Loperamide (Impelium)

• µ-opioid agonist → reduces GI motility
• Prefer only if diarrhea is non-bloody and afebrile
• Avoid in suspected invasive diarrhea (bloody stool, high fever)
• Not suitable for children < 2 years

🟢 2. Abdominal Cramp / Colic

✅ Preferred: Hyoscine Butylbromide (Amcopan, Buscopan)

• Anticholinergic spasmolytic
• Relieves colicky abdominal pain
• Minimal systemic absorption
• Safe short-term relief in viral and toxin-mediated diarrhea

⚠️ Avoid in:

• Elderly with BPH or glaucoma
• Constipation-dominant patients

🟢 3. Nausea and Vomiting (N/V)

✅ Preferred: Domperidone (Motidom-M)

• Peripheral D2 antagonist
• Increases gastric motility
• Minimal extrapyramidal side effects due to poor CNS penetration
• Well-tolerated even in children

⚠️ Use with Caution: Metoclopramide (Maxolon)

• Central + peripheral D2 antagonist
• EPS risk (esp. in adolescents, young women)
• Preferred only in migraine-associated nausea or severe vomiting in adults

🟢 4. Antibiotic (Only if Indicated)

✅ Preferred in Bacterial Food Poisoning: Norfloxacin 400 mg BID x 3–5 days

• Fluoroquinolone with gram-negative coverage
• Indicated in:
  • Profuse watery diarrhea with signs of systemic illness
  • Traveler’s diarrhea
  • Suspected bacterial gastroenteritis with high fever

⚠️ Not Preferred for Viral Gastroenteritis

• Antibiotics are not helpful in most viral AGE cases
• Overuse leads to resistance and gut flora disruption

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🚫 When to Avoid Medications:

📝 Example Thai OPD Prescription (Non-bloody AGE)

1. ORS Powder – 1 sachet per 200 ml, sip frequently
2. Dehecta (Diosmectite) – 1 sachet TID between meals
3. Domperidone 10 mg – 1 tab TID before meals
4. Hyoscine 10 mg – 1 tab TID after meals (prn for cramping)
5. Norfloxacin 400 mg – 1 tab BID x 3 days (only if bacterial signs)

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🧠 Take-Home Summary Table

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💬 Patient Advice

• Maintain hydration with ORS, especially with fever or frequent diarrhea
• Watch for red flags: persistent fever, bloody stools, decreased urine, altered mental status
• Avoid raw/undercooked meat, unpasteurized milk, street food in poor hygiene areas

Would you like me to create an OSCE summary table or SOAP note format from this article?