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Got mild fever, nausea, diarrhea and cramps. Not cured by medicine. What should be done?

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General Surgeon
Practicing since : 2008
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I have a stomach flu starting with diarrhea and cramps. Then for a day or two, diarrhea went away but then came back. Couple tests showed no bacteria yet but still waiting for 2 more results (parasite and stool culture). I was prescribed antibiotic CIPRO, and it is half way, doctor told me I can stop based on my request as I think this is unsure bacteria cause. While waiting for all the results, my stomach cramp is driving me crazy, sometimes with very mild fever and nausea. Taking tynenol helps little bit and I have been drinking lots of water. This has been going on for 7 days already. I am a healthy 45 male and never have a stomach flu this long.
Posted Thu, 7 Feb 2013 in Digestion and Bowels
Answered by Dr. Grzegorz Stanko 1 hour later

Thank you for the query.

Such intermittent diarrhea sometimes can be a symptom of partial bowel obstruction. It happens when the intestine gets blocked for some reason (adhesions, inflammatory bowel disease, tumors). This leads to stool accumulation what lasts a day or two. If there is enough stool in the intestines to force the obstruction it suddenly opens and causes fast stool passage as the large intestine is not prepared for it and can not absorb the water from it.
Such obstruction gives abdominal pain (craps which are trying to force it), bloating, the abdomen gets bigger. Between the diarrheas, there is no gas excreted and nausea appears.
This obstruction is more possible if you have had constipations before or diarrheas, lost some weight recently, feel week, have had some blood or mucus in stool.
It should be diagnosed with abdominal X-ray (can show the obstruction when you have cramps) and abdominal CT with oral contrast (called enteroclysis).
Colonoscopy should be also performed.
The other possible reason is bacterial inflammation indeed. Ciprofloxacine itself is not effective for all bacterias, that is why it should be prescribed with Metronidazole (such treatment should take Ciprofloxacine 500 mg twice a day and Metronidazole 500 mg twice a day for 7 days). Moreover, when stop taking it in the middle of the course you leave the bacterias stronger and resistant for it what can cause hard to treat infection.
In conclusion, you should have abdominal obstruction ruled out with an X-ray and CT. If ruled out, you should have fool course of Metronidazole and Ciprofloxacine. You can also add Rifaximine 400 mg 3x1 for 7 days.The last one is an antibiotics which does not get absorbed to the blood and works only in the intestine.

Hope this will help. Feel free to ask further questions.
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