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My Girlfriend And I Live In Vietnam. We Both Got

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Posted on Mon, 6 May 2019
Question: My girlfriend and I live in Vietnam. We both got a stomach bug about two weeks ago.

My symptoms are that after eating, I feel mild nausea and discomfort, followed by violent diarrhoea 30-60 minutes later. All stool movements are loose. Other than that, it hasn't been too bad.

I went to a local pharmacy last night, and they gave me some lactobacillus lb sachets, and mebeverine 200mg. Since starting to take these, my symptoms are much worse. A hot, nauseous feeling almost constantly, and much more frequent bouts of diarrhoea.

Should I discontinue this treatment, or stick it out?

Is there anything else you recommend that I try?

Many thanks
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Follow up: Dr. Aaron Branch (0 minute later)
My girlfriend and I live in Vietnam. We both got a stomach bug about two weeks ago.

My symptoms are that after eating, I feel mild nausea and discomfort, followed by violent diarrhoea 30-60 minutes later. All stool movements are loose. Other than that, it hasn't been too bad.

I went to a local pharmacy last night, and they gave me some lactobacillus lb sachets, and mebeverine 200mg. Since starting to take these, my symptoms are much worse. A hot, nauseous feeling almost constantly, and much more frequent bouts of diarrhoea.

Should I discontinue this treatment, or stick it out?

Is there anything else you recommend that I try?

Many thanks
doctor
Answered by Dr. Aaron Branch (53 minutes later)
Brief Answer:
You could discontinue your current medications

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor. The treatments they gave you treat for irritable bowel syndrome, and to help recover from diarrhea. Neither one of them would be necessary, so it would be safe to discontinue them, and if they seem to be making things worse, I think it would be reasonable to stop them.

If you are able to get any medication from the pharmacies there, I would suggest taking Azithromycin 500 mg once a day for 3 days to eliminate any bacterial cause of the diarrhea. With diarrhea lasting this long, parasitic causes are also common, so I would suggest taking Albendazole 400 mg once a day for 5 days, with ivermectin 200 mcg/kg (usually 12 mg) once daily for 2 days. You can take all these medications at the same time with no problem.

I would expect that to clear it up. If not, you may need stool studies to figure out what the cause would be, but hopefuly that won't be necessary.

I hope that helps, please let me know if you have any questions about any of that, and I would be glad to discuss it with you further.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You could discontinue your current medications

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor. The treatments they gave you treat for irritable bowel syndrome, and to help recover from diarrhea. Neither one of them would be necessary, so it would be safe to discontinue them, and if they seem to be making things worse, I think it would be reasonable to stop them.

If you are able to get any medication from the pharmacies there, I would suggest taking Azithromycin 500 mg once a day for 3 days to eliminate any bacterial cause of the diarrhea. With diarrhea lasting this long, parasitic causes are also common, so I would suggest taking Albendazole 400 mg once a day for 5 days, with ivermectin 200 mcg/kg (usually 12 mg) once daily for 2 days. You can take all these medications at the same time with no problem.

I would expect that to clear it up. If not, you may need stool studies to figure out what the cause would be, but hopefuly that won't be necessary.

I hope that helps, please let me know if you have any questions about any of that, and I would be glad to discuss it with you further.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Aaron Branch (25 minutes later)
Thank you XXXXXXX for this clear and very helpful answer.

I have just taken a single tablet of mebendazole 500mg, which is what the pharmacies give out here, because I suspected it might be parasitical.

I will discontinue the other medications, monitor my symptoms, and if they're not clearing up in a few days, will proceed as you advise.

All the best XXXXXXX
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Follow up: Dr. Aaron Branch (0 minute later)
Thank you XXXXXXX for this clear and very helpful answer.

I have just taken a single tablet of mebendazole 500mg, which is what the pharmacies give out here, because I suspected it might be parasitical.

I will discontinue the other medications, monitor my symptoms, and if they're not clearing up in a few days, will proceed as you advise.

All the best XXXXXXX
doctor
Answered by Dr. Aaron Branch (1 hour later)
Brief Answer:
Sounds good

Detailed Answer:
You're welcome. Your plan sounds good. If the diarrhea persists, I would suggest taking mebendazole 200 mg three times a day for 5 days to cover for giardia, which often is a cause of diarrhea in southeast asia.

Please let me know if I can do anything else to help.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Sounds good

Detailed Answer:
You're welcome. Your plan sounds good. If the diarrhea persists, I would suggest taking mebendazole 200 mg three times a day for 5 days to cover for giardia, which often is a cause of diarrhea in southeast asia.

Please let me know if I can do anything else to help.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (18 minutes later)
Thanks for the reply.

To clarify - would the mebendazole 200 mg be taken in place of the other anti-parasite medicines you listed in your first reply? Or in addition to?

Many thanks XXXXXXX
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Follow up: Dr. Aaron Branch (0 minute later)
Thanks for the reply.

To clarify - would the mebendazole 200 mg be taken in place of the other anti-parasite medicines you listed in your first reply? Or in addition to?

Many thanks XXXXXXX
doctor
Answered by Dr. Aaron Branch (1 hour later)
Brief Answer:
Good question

Detailed Answer:
Yes, the mebendazole would replace the albendazole, I would still take the ivermectin (for a parasite called strongyloides), and the azithromycin (for bacterial causes of diarrhea), though the longer you have the diarrhea, the less likely you have a bacterial cause and the more likely you have a parasite. But I would take all of them if the diarrhea persists, just in case.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Good question

Detailed Answer:
Yes, the mebendazole would replace the albendazole, I would still take the ivermectin (for a parasite called strongyloides), and the azithromycin (for bacterial causes of diarrhea), though the longer you have the diarrhea, the less likely you have a bacterial cause and the more likely you have a parasite. But I would take all of them if the diarrhea persists, just in case.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (3 hours later)
Thanks Arron, crystal clear now. Have a good day!
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Follow up: Dr. Aaron Branch (0 minute later)
Thanks Arron, crystal clear now. Have a good day!
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Follow up: Dr. Aaron Branch (0 minute later)
Aaron* sorry :)
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Follow up: Dr. Aaron Branch (0 minute later)
Aaron* sorry :)
doctor
Answered by Dr. Aaron Branch (9 hours later)
Brief Answer:
You're welcome

Detailed Answer:
You're welcome, I'm glad I could help.
Please let me know if I can help with anything in the future.

Thank you
Take care


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You're welcome

Detailed Answer:
You're welcome, I'm glad I could help.
Please let me know if I can help with anything in the future.

Thank you
Take care


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Aaron Branch (6 hours later)
Hey, one more question please.

I managed to get hold of the Azithromycin and the Albendazole, but couldn't get hold of the Ivermectin after trying 3 different pharmacies - seems it is not so commonly available out here.

When I was here April 2018, I had an infection of entamoeba histolytica. I was given metronidazole to treat it back then. Should I take this as well, to cover all bases, or is it covered by one of the other meds you suggested?

Back then, I had a really high fever and had to be hospitalised, but so far during this bout of illness, no fever.

Thanks XXXXXXX
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Follow up: Dr. Aaron Branch (0 minute later)
Hey, one more question please.

I managed to get hold of the Azithromycin and the Albendazole, but couldn't get hold of the Ivermectin after trying 3 different pharmacies - seems it is not so commonly available out here.

When I was here April 2018, I had an infection of entamoeba histolytica. I was given metronidazole to treat it back then. Should I take this as well, to cover all bases, or is it covered by one of the other meds you suggested?

Back then, I had a really high fever and had to be hospitalised, but so far during this bout of illness, no fever.

Thanks XXXXXXX
doctor
Answered by Dr. Aaron Branch (3 hours later)
Brief Answer:
I would wait

Detailed Answer:
Entamoeba histolytica is a good thing to think about, but like you said, when it causes symptoms, they are typically severe, and almost always have blood in the diarrhea. So assuming you don't see any blood, I would hold off on treating that for now and start with the treatments we already talked about. If you are not better within a week or two after that, you will probably need to get studies done to figure out what is causing it. But I would expect these should take care of it.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
I would wait

Detailed Answer:
Entamoeba histolytica is a good thing to think about, but like you said, when it causes symptoms, they are typically severe, and almost always have blood in the diarrhea. So assuming you don't see any blood, I would hold off on treating that for now and start with the treatments we already talked about. If you are not better within a week or two after that, you will probably need to get studies done to figure out what is causing it. But I would expect these should take care of it.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Aaron Branch (28 minutes later)
Ok thanks again XXXXXXX all the best
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Follow up: Dr. Aaron Branch (0 minute later)
Ok thanks again XXXXXXX all the best
doctor
Answered by Dr. Aaron Branch (14 hours later)
Brief Answer:
You're welcome

Detailed Answer:
You're welcome, I hope you and your girlfriend get over this soon.

I am currently in Cambodia so I treat and deal with a lot of this same stuff. Feel free to request me next time you have any problems and I would be glad to help.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You're welcome

Detailed Answer:
You're welcome, I hope you and your girlfriend get over this soon.

I am currently in Cambodia so I treat and deal with a lot of this same stuff. Feel free to request me next time you have any problems and I would be glad to help.

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Aaron Branch

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My Girlfriend And I Live In Vietnam. We Both Got

My girlfriend and I live in Vietnam. We both got a stomach bug about two weeks ago. My symptoms are that after eating, I feel mild nausea and discomfort, followed by violent diarrhoea 30-60 minutes later. All stool movements are loose. Other than that, it hasn't been too bad. I went to a local pharmacy last night, and they gave me some lactobacillus lb sachets, and mebeverine 200mg. Since starting to take these, my symptoms are much worse. A hot, nauseous feeling almost constantly, and much more frequent bouts of diarrhoea. Should I discontinue this treatment, or stick it out? Is there anything else you recommend that I try? Many thanks