First step

Fever?  Blood?  Flatulence?

1-Mild without fever

Oral Rehydration Solution or Coca-Cola (not loperamide!!!)

2-Without fever

"Non-absorbable antibiotic"(Coccila, Ercefuryl…) 1-2tab 4x/day

3-With fever

Norfloxacin 200mg 1tab 2x/day.  If not better then metronidazole400mg 1tab 3x/day (+/- loperamide)

4-With blood

Ciprofloxacin 500mg 3x/day.  If not better, then metronidazole400mg 3x/d

5-With flatulence

Metronidazole 400mg 3x/day (Giardiosis?)  (+/- loperamide)

6-Anemic... worms?

7-Lymph node in abdomen + TB signs...

8-Nothing is working?

Albendazole 200mg 2tabs 2x/day (microsporidias?)  (+/- loperamide)

9-Still nothing is working...

10-Still nothing is working...

Loperamide 1-4tabs 4x/day

Second step: try to look at stool/diaper...

...And change your decision if you feel it is necessary (you can never be sure that fever is connected with diarrhea; and patients often do not accurately describe rectorrhagia or smells...)

8- Mucus

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Mucus means that colon pathology is involved.  Absence of mucus means supracolonic or anal problem.  Only mucus often means parasites...  If you are unsure, try metronidazole, mebendazole...

9- "Cow dung"

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Think about Giardiosis first, especially if severe aerophagy...  Treat with metronidazole even if neither fever nor blood.

10- Red blood (mixed in stool)

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Lesions are probably high in colon...  Try metronidazole even if patient has no fever.  Think also about worms.

11- Red blood (not mixed into stool)

Without mucus

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If no mucus, can be hemorrhoids or an anal fissure, or rectal polyps...  ("4-Anal Area") But if there is "bloody mucus" (like a red sauce) on the stool, the cause is probably a "lesion" higher in the colon and you should try metronidazole.  Consider also worm diagnosis.

With mucus

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12- "Black tar"

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Melena?  (Has a typical bad smell).  Often patients need a gastric treatment more than an antibiotic (see "21-Stomachache")...  We can also suspect hemostatic problems...  (See "16-Hemorrhagia").  Common in last step of long & difficult agony... just before die...

13- "Black stools"

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Mild melena?  Not all black stools are melena...  (Smell)  Darkness can also come from the iron in anti-anemic drugs or from a rich protein diet...

14- "Green stools"

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I still wait for professional advice...  Now, even if no fever is present, I prefer to start immediately with metronidazole...

15- Aqueous diarrhea

Not homogeneous stool

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I am still waiting for good advice to help me make a clear distinction between "homogeneous" and "not homogeneous" aqueous stools.

If "only" aqueous diarrhea, good hydration must be the first goal...  Often a virus is the cause and antibiotics are useless.  Try albendazole if nothing else works... and loperamide only if albendazole is also ineffective.

Homogeneous stool

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16- "White stools"

Think about hepatic failure, especially if urine is dark and icterus also present.  Viral cause?  Adverse drug effect (common with AIDS patients)?  Biliary obstruction?...

17- Visible worms...