The management of acute diarrhoea in a healthy adult population deploying on military operations.

ABSTRACT

Acute diarrhoea is consistently the number one presentation to secondary care facilities on U.K. military operational deployments. It can result in potentially life threatening consequences as seen on Operation Herrick in 2002, where a Norwalk-like virus caused 3 cases o f meningo-encephalitis. Due to t he circumstances of communalaccommodation, ablutions and dining facilities, even mild cases are admitted at role 2, and personnel are not discharged until fully recovered in order to prevent potential outbreaks. This literature review examines the management of acute diarrhoea in healthy adults relating to UK military operations, and presents a management algorithm suitable for any theatre. The importance of the initial assessment is highlighted and allows the severity of the condition to be assessed using three key parameters. We recommend the selective use of stool culturing for severe cases and outbreaks. The use of oral re-hydration solutions vs. intravenous fluids, and the indication for the safe use of anti motility agents and antibiotics for diarrhoea are discussed. Where pathogens are yielded local sensitivities should guide the choice of treatment. Salmonella spp and Shiga toxin-producing E.coli (STEC) should receive supportive care only.