Acute gastroenteritis

• Isolate in side room and follow standard and transmission based infection control recommendations on the intranet.
• Replace electrolytes and fluid.
• Avoid loperamide, opiates and NSAID medication where possible
• If patient is on a PPI/H2 antagonist review if this is still required; stop if possible.
• If patient is septic consider treating with antibiotics as per surgical intra-abdominal infections.

• Stool cultures x3
• Stool for Norovirus PCR (or vomit - do not send vomit for culture)
• Blood cultures if febrile

• Antibiotics worsen outcome in STEC (E.coli 0157) infection.
• Antibiotics can prolong carriage in Salmonella infection.
• Campylobacter/Shigella and Salmonella are usually treated conservatively.

Consider antibiotic treatment for people where Campylobacter/Shigella/Salmonella has been isolated:

• With severe symptoms (high fever, bloody diarrhoea, or more than eight stools per day).
• Who are immunocompromised.
• Whose symptoms appear to be worsening.
• Whose symptoms have lasted longer than 1 week.

Likely organisms:Viral, Salmonella, Campylobacter, Shigella, E.coli including STEC (O157).

• Offer HIV testing in patients where Campylobacter/Shigella or Salmonella has been isolated.
• Outbreaks of Shigella have been linked to person-to-person spread among men who have sex with men.