Chronic diarrhoea

Signs and symptoms

More than 3 loose non-bloody motions per 24 hours for more than 4 weeks (adults) or 2 weeks (children)

Investigations

Based on response to stepwise empirical treatment:

Step 1 treats: isospora, cyclospora, bacterial Step 2 treats: giardia, clostridium, amoeba Step 3 treats: microsporidium, helminths

Treatment

Effective ART Confirm VL suppression, do targeted CD4; consider if LPV/r is causing the diarrhoea.

ORS (Thanzi)

Drink 5ml/kg 4-hourly and after every episode of diarrhoea Drink 5ml doses every 5 min if vomiting occurs IV Fluids if severe de-hydration Loperamide tablets Adult: 2mg after every loose stool (max 12mg in 24 hours)

Child: Do NOT use for children Step 1: Cotrimoxazole tablets Adult: 960mg 8-hourly for 7 days Child: 80 mg/kg 8-hourly for 7 days Zinc tablets Give for 10 days Child 0-6mths: 10 mg 24-hourly Child 6m – 5 yrs:20 mg 24-hourly Secondary management Continue with step 2 and 3 if no improvement Step 2: Metronidazole tablets Adult: 800mg 8-hourly for 7 days Child: 15mg/kg 8-hourly for 7 days Step 3: Albendazole tablets Adult: 400mg 12-hourly for 3 – 4 weeks Child: 15mg/kg/day divided in 2 doses for 3 – 4 weeks