Abstract

KUDSK-IVERSEN, S; GILBERT, J P  and  AZARATH, A. Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance. South. Afr. j. HIV med. (Online) [online]. 2014, vol.15, n.3, pp.102-103. ISSN 2078-6751.  http://dx.doi.org/10.7196/SAJHIVMED.1082.

BACKGROUND: HIV is prevalent throughout South Africa, and diarrhoea is a common presentation to the emergency department (ED) among both HIV-infected and -uninfected individuals. METHOD: We audited the management of diarrhoea against standard guidelines in the ED of a regional hospital in KwaZulu-Natal. Patients presenting with diarrhoea as their chief complaint were eligible and data were collected prospectively. RESULTS: A total of 72 patients were included: 58 (81%) of patients were HIV-positive with an average CD4⁺ count of180 cells/μl. A total of 34 stool samples were sent for standard microscopy and culture (M&C), among which 26 were positive (76%). Forty-three patients (60%) received antibiotics, 15 of whom had positive stool M&C. In all cases, the final diagnosis was listed as acute gastroenteritis without further specification, and antibiotic use according to guidelines appeared inconsistent. CONCLUSION: Based on this audit, we suggest that current guidelines are not clear concerning management of acute diarrhoea in HIV-infected individuals, and that the lack of clear management strategies is likely to affect patient safety and increase antibiotic resistance.

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