How to deal with watery and smelly diarrhea and abdominal pain for almost two weeks?

Question

Hi doctor,

I have had diarrhea for almost two weeks, watery to mushy, yellow. Sometimes have a foul smell. Reduced appetite and abdominal pain, and I felt some movement in my lower abdomen along with bowel sounds. I started on Racecadotril, Bacillus clausii probiotic, and Ciprofloxacin to no avail, then switched to Rifaximin 200 milligrams twice a day, but I did not feel any better. I had taken blood tests, ultrasound, stool exam, and stool culture exam. A stool culture exam shows a Staphylococcus aureus heavy overgrowth in stool, but my primary GI dismissed it since he believes it only manifests on the skin. I am seeking for a second opinion since I read a medical article about Staphylococcus aureus living in the intestines.

Thank you.

Answer 1

Hi,

Welcome back to icliniq.com.

I have reviewed your case history and attached laboratory investigations in detail (attachments removed for patient identity protection).

1) Your stool culture shows Staph aureus with significant antibiotic resistance, which is not usually community-acquired; this is likely contamination in the laboratory.

2) Your reports suggested raised liver enzymes with fatty liver on ultrasound; you also have to take care of this element.

3) Similarly, your uric acid is raised too.

4) You have used multiple antibiotics for your diarrhea.

My suggestions would be.

Either go for three days antibiotics combination including Ciprofloxacin 500 mg once in the morning and once in the evening along with tablet Metronidazole 400 mg three times a day (for three days).
Another option is Rifaximin, but again you used a low dose of 200 mg, an adult dose for treating such cases, and 550 mg twice daily for 7 to 10 days.
Meanwhile, stop eating out, home-cooked soft meals only.
Avoid alcohol, considering your liver.
Reduce weight if your BMI (body mass index) is more than 25.
Continue with probiotics; if currently not practical, switch to another brand.
Take yogurt daily.

Thank you.