From the Guidelines
Diarrhea among homeless individuals is most effectively managed by prioritizing oral rehydration and addressing underlying causes, with the most recent guidelines from 2017 (1) emphasizing the importance of proper fluid and electrolyte intake for replacement and maintenance.
Causes of Diarrhea
The causes of diarrhea among homeless individuals are multifaceted, including:
- Foodborne pathogens
- Viral infections
- Bacterial infections
- Parasitic infections Poor access to clean food and water sources, limited hygiene facilities, and crowded shelter conditions all contribute to the spread of infectious agents 1.
Treatment
For treatment, oral rehydration is essential, using solutions containing water, salt, and sugar (1 teaspoon salt, 8 teaspoons sugar in 1 liter of clean water if commercial solutions aren't available) 1. Antimotility agents like loperamide (4mg initially, then 2mg after each loose stool, maximum 16mg/day) can provide symptomatic relief for non-bloody diarrhea. For suspected bacterial infections with fever or bloody diarrhea, antibiotics may be needed - ciprofloxacin 500mg twice daily for 3-5 days is often effective 1.
Prevention Strategies
Prevention strategies include:
- Providing access to clean water
- Hand sanitizer distribution
- Education about food safety
- Improving shelter conditions to reduce overcrowding Underlying conditions like chronic alcoholism, which is more prevalent in homeless populations, can also contribute to chronic diarrhea and should be addressed when possible 1.
Key Considerations
The most recent guidelines from 2017 (1) highlight the importance of avoiding dehydration and ensuring adequate fluid and electrolyte intake for replacement and maintenance. Additionally, the guidelines emphasize the need for appropriate use of antimicrobial agents and antimotility drugs to prevent resistance and worsening illness.
From the FDA Drug Label
that diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
Diarrhea Etiology: The FDA drug label indicates that diarrhea can be a common problem caused by antibiotics, including ciprofloxacin. It also states that ciprofloxacin is indicated for the treatment of infectious diarrhea caused by certain strains of bacteria, such as Escherichia coli and Campylobacter jejuni. However, it does not provide information on the etiology of diarrhea in homeless individuals. 2 2
From the Research
Diarrhea Etiology in Homeless Populations
- Diarrhea is a significant health concern for homeless individuals, particularly children, due to poor living conditions and limited access to healthcare 3.
- Homeless people are at risk for numerous health hazards, including diarrhea and consequent dehydration, which can quickly become a medical emergency if not treated promptly 3.
- Education is a fundamental tool in the prevention of disease, and educating homeless parents on recognizing and treating mild, acute diarrhea and secondary dehydration can help prevent medical complications 3.
Oral Rehydration Therapy
- Oral rehydration therapy is an effective and inexpensive treatment for dehydrating diarrhea, and its use has been widely recommended and adopted in developing countries 4.
- The World Health Organization recommends a standard oral replacement solution that has been shown to be safe and effective in treating dehydration 4.
- However, some studies suggest that traditional oral rehydration solutions may not be optimized for treating diarrhea, and that novel formulations using starches, cereals, and/or amino acids may be more effective 5.
Interventions for Homeless Populations
- Nurse-led interventions have been shown to be effective in improving health outcomes for homeless populations, and a holistic nursing approach can help address the complex physical, mental, and social health problems faced by this population 6.
- Emergency department interventions, such as housing first initiatives and case management, can also be effective in improving the social determinants of health of homeless individuals and breaking the cycle of homelessness 7.