7.5.2
Chronic Diarrhoea
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 7, Gastrointestinal Conditions.
Clinical Description
Passage of loose stools > 3 times/day for > 4 weeks. Common presentation in HIV/AIDS patients.
Signs and Symptoms
- Diarrhea +/- abdominal pain
Investigations
- Full blood count
- Stool analysis
- HIV test
- Urea, creatinine and electrolytes
Non-pharmacological
please refer to the acute diarrhoea section
Adults
- Replace fluids and electrolytes
- oral rehydration solution
- If severe dehydration/hypovolaemia: IV fluids, preferably Ringer’s Lactate treat underlying cause.
- if HIV positive
- ensure patient is on effective ART
- empiric treatment
- Cotrimoxazole 1920mg PO 12 hourly for 14 days (to treat Isospora)
- If no improvement on Cotrimoxazole, Metronidazole 2g po 24 hourly for 5 days (to treat Giardia).
o if no improvement on Metronidazole, Albendazole 400mg every 12 hourly PO for 14 days (to treat Microsporidia)
- Anti-motility agents
- Loperamide 4mg initially then 2mg after each loose stool (maximum 16mg per day) o alternative: Codeine Phosphate 30mg 8 hourly PO for 5 days
Avoid anti-motility agents in colitis/bloody diarrhoea – may precipitate toxic mega colon
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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