Question

A 40 year-old man presents at the local health clinic in rural Ireland for the evaluation of diarrhea and abdominal discomfort, which have been worsening for the past 10 days. The man reports having 8-12 watery stools a day for each of the past 5 days, and has frequent mild cramping pain. The man has not traveled recently, denies contact with anyone ill and reports no history of GI issues or disease. He requests a course of antibiotics and to be on his way. He assumes his issues were due to some greenish Guinness consumed a few weeks back in celebration of St. Paddy's. Upon probing further regarding his knowledge of antibiotics the PA learns that the man took a course of Augmentin 14 days ago that were prescribed for his wife, and since she didn’t use them, he took them to clear his “bout of pneumonia”. Promptly, the man leaves to defecate, and the PA asks the man to collect some stool in a collection cup. Upon his return his vitals were taken to be: BP - 100/80 mm/Hg; Breathing - 15 breaths per minute; Pulse - 72 beats per minute Examination revealed he is mildly ill appearing. His abdomen is soft, diffusely mildly tender, and he has hyperactive bowel sounds even without a stethoscope. The stool sample shows no evidence of blood. Given the nearest clinical micro lab is 1h drive away and the man is not interested in taking his stool sample there, the PA performs a simple stain on the stool, and notices it is positive for leukocytes. The PA also plates it on a MAC plate and a BAP plate and grows them aerobically for 24h. The PA reports that the plates were unremarkable: no pathogen overgrowth.

What is the diagnosis and what treatment should be prescribed?

Answer 1

Augmentin is a combination of the dirug amoxicillin with clavulinic acid and the patiient might be allergic to this medication thats the reason why the man faced this type of coidition of diarrhoea and abdominal cramp is due to the rare reaction of Augmentin. the stain test which is performed which tests postive for leukocytes iw WBC suggests that the patient is suffering for wattery diarrohoe, since the BAP (blood agar plate ) and MAC (mc. conkeys agar ) plate culture is negative it shows that there is nothing is significantly wrong with the enteric system or no infestation of a gram negative bacteria too,

Since the diarrhea is not due to any enteric problem and mainly as a side effect of augmentin, the patient should be put on a normal diet and should be put on anti-diarrheal drug such as loperamide till symptosm of diarrhea resolve, at the same time it becomes the duty of the PA to give him a medication whenever he faces bouts of pneumonia attacks for which he can take other antibiotics like fluroquinolone or cephalosporins.

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