Quinolone-resistant diarrhea

[Fitdoc]

Doc,

Do you know if the traveler's diarrhea often acquired in DengFeng is susceptible to traditional quinolones, eg, cipro or is there an abundance of campylobacter induced diarrhea (ie quinolone resistant)?

Thanks

[daodejing]

This may or may not help, but if you can find an herbal pharmacy in dengfeng, Huo Xiang Zheng Qi San (or Huo Xiang Zheng Qi Shui, the liquid form) is great for travellers diarrhea, especially if you're nauseous as well.

[doc]

Good question, and one that we can spend a lot of time talking about.

Cipro is effective for Campylobacter jejuni, and, is effective for most cases of Camplyobacter coli. It's been my experience that it works for GI infections obtained in Dengfeng.

HOWEVER, let's talk a little about the shits, eh?

Campylobacter is not the only cause of traveler's diarrhea, as you well know. E Coli, I think, is more commonly found there, though, I always seem to fail to bring my little microbiology laboratory with me. Poor sanitation is most likely the cause. Now, with E coli gastroenteritis, unless you're severely infected, antibiotics are not the main treatment: supportive care is. Aggressive fluid and electrolyte therapy, and time, usually takes care of the issue within a few days to a week. Aggressive diarrhea, and by that, I mean, three or more "visits" within an 8 hour period, might indicate the necessity for antibiotics. Bactrim, Flagyl, and Cipro are effective. Beware of the rare incidence of hemolytic uremia syndrome using Cipro in E coli GI infections. Also, Cipro with longer term usage can affect cartilage in weight bearing joints, and, can also affect the strength of tendons in the body. Achilles tendon rupture has been reported with Cipro usage.

I generally get the Dengfeng squirts when I go there, and I usually do not use antibiotics. Hydration, electroylyte replenishment and time usually heal these things. I had one episode where I was pretty damn sure I got Salmonella; had one of those awesome baked chickens on the street one day, and spent the next few days ruling the porcelain throne, with high fever and generalized weakness.

My worst episode was in Xinjiang province, in Kashi. Had I i thought was an "intentional" gastroenteritis. Was in this heavily muslim province a week before 9/11, ate an identical meal in this restaurant with my Chinese friend, and within two hours, was on the bathroom floor hypovolemic and tachycardic. I was wiped out for days, absolutely bedridden; had to force fluids and dose myself with Flagyl and Cipro. Never been that sick from GI illness in my life. No doubt someone didn't like Americans there, and put a hefty dose of E coli in my hamburger. Just goes to show, being careful doesn't necessarily prevent these things.

Bismuth preparations can be helpful, however you need to take relatively large doses for this to be effective. Taking it pre-emptively is not always effective. Pepto Bismol is good, but, beware using it if you have asthma or aspirin sensitivity. It contains salicylates, and if you're allergic to aspirin, you might react to the pink pill / juice. Using aspirin for pain will only lead to more GI irritation.

Antibiotics are generally not indicated with acute gastroenteritis; you can alter the normal intestinal flora, which might lead to further problems. You're well aware of clostridial gastroenteritis. Also, taking motility diminishing drugs might actually prolong the illness, as you're hampering the "flushing out" effect that the body is using to excrete the toxins. If you support the body and let it do its thing, you'll get better.

I've written extensively, somewhere, about how to avoid getting the Dengfeng Drip. Essentially, eat nothing that is not cooked or peeled. Even watermelon, which I relish to replace electolytes and water, is cut with a knife, that cuts through the filthy rind into the fresh fruit below. Plates are washed with dirty water, as are glasses. Drink out of bottles, and use napkins to wipe your dinner plate. Make sure that bottles are sealed: i've watched little kids take old used bottles and fill them with water for resale to stores later. Remember, the Chinese use human shit to fertilize their crops. Talk about sharing your illness with the community. Don't ever eat ice cream or other dairy type products from anything but Haagen Daaz or Baskin Robbins (which you'll find in Beijing). Talking about western restaurants, expect to find Pizza Hut using ketchup as a "pizza sauce" replacement. If that doesn't give you the shits, nothing will. Oh, and try to eat at the better restaurants. Street stands will get you into trouble. Remember, refrigeration is basically non-existant; if it got killed and cooked, it has to be eaten that day. Problem is, they sometimes aren't.

I've had trips where I did not get sick. Occasionally, but true. And no, you don't get resistant to these diseases. Walk into any public latrine, and take a good look around. You'll find that most of the population is infected with something. These GI disorders are commonplace there, because the Chinese have not yet figured out the necessity for good sanitation. Natives shitting in the river upstream of people washing their clothes and dishes is a favorite epidemiology image of mine.

[onesp1ng]

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