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The antimotility agent loperamide Imodium may reduce the duration of diarrhea by as much as one day and increase the likelihood of clinical cure at 24 and 48 hours when given with antibiotics for traveler's diarrhea.

Loperamide may cause dangerous prolongation of illness in patients with some forms of bloody or inflammatory diarrhea and, therefore, should be restricted to patients with nonbloody stool.

The antisecretory drug racecadotril, widely used in Europe but unavailable in the United States, appears to be more tolerable and as effective as loperamide.

Because acute diarrhea is most often self-limited and caused by viruses, routine antibiotic use is not recommended for most adults with nonsevere, watery diarrhea.

Additionally, the overuse of antibiotics can lead to resistance e. However, when used appropriately, antibiotics are effective for shigellosis, campylobacteriosis, C.

Antibiotic treatment of traveler's diarrhea usually a quinolone is associated with decreased severity of illness and a two-or three-day reduction in duration of illness.

Table 4 summarizes antibiotic therapy for acute diarrhea. If an antimicrobial agent is causing the diarrhea, it should be discontinued if possible.

Enterotoxigenic E. Options for severe disease: Ciprofloxacin, mg twice per day for 5 to 7 days. In addition to patients with severe disease, it is appropriate to treat patients younger than 12 months or older than 50 years, and patients with a prosthesis, valvular heart disease, severe atherosclerosis, malignancy, or uremia.

The role of antibiotics is unclear; they are generally avoided because of their association with hemolytic uremic syndrome.

Vibrio cholerae. Doxycycline and tetracycline are not recommended in children because of possible tooth discoloration.

Not needed in mild disease or enteritis, proven in severe disease or bacteremia. Therapy may not be necessary in immunocompetent patients with mild disease or in patients with AIDS who have a CD4 cell count greater than cells per mm 3.

Option for severe disease: Nitazoxanide Alinia , mg twice per day for 3 days may offer longer treatment for refractory cases in patients with AIDS.

Highly active antiretroviral therapy, which achieves immune reconstitution, is adequate to eradicate intestinal disease in patients with AIDS.

Metronidazole, mg three times per day for 5 to 10 days, plus paromomycin, 25 to 35 mg per kg per day in 3 divided doses for 5 to 10 days.

Tinidazole Tindamax , 2 g per day for 3 days, plus paromomycin, 25 to 35 mg per kg per day in 3 divided doses for 5 to 10 days.

If the patient has severe disease or extraintestinal infection, including hepatic abscess, serology will be positive. Information from references 1 , 14 , 16 , 44 , and Probiotics are thought to work by stimulating the immune system and competing for binding sites on intestinal epithelial cells.

Their use in children with acute diarrhea is associated with reduced severity and duration of illness an average of about one less day of illness.

Effects of strain-specific probiotics need to be verified in adult studies before a specific evidence-based recommendation can be made.

Research in children suggests that zinc supplementation 20 mg per day for 10 days in children older than two months may play a crucial role in treating and preventing acute diarrhea, particularly in developing countries.

Good hygiene, hand washing, safe food preparation, and access to clean water are key factors in preventing diarrheal illness.

Effective and safe vaccines exist for rotavirus, typhoid fever, and cholera, and are under investigation for Campylobacter , enterotoxigenic E.

To contain disease outbreaks, designated diseases should be reported to public health authorities. In the United States, reportable diarrheal illnesses include those caused by Vibrio cholerae , Cryptosporidium , Giardia , Salmonella , Shigella , and Shiga toxin—producing E.

Keywords were acute diarrhea, evaluation of acute diarrhea, Clostridium difficile , testing in acute diarrhea, and diagnostic testing in acute diarrhea.

Search dates: March to April , and December Already a member or subscriber? Log in. Reprints are not available from the authors.

Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. The global burden of diarrhoeal disease, as estimated from studies published between and Bull World Health Organ.

Foodborne illness acquired in the United States. Emerg Infect Dis. Foodborne illness acquired in the United States—unspecified agents. DuPont HL.

Diarrheal diseases in the developing world. Infect Dis Clin North Am. Changing epidemiology of food-borne disease: a Minnesota perspective.

Acute diarrhea: a practical review. Am J Med. Laboratory approaches to infectious diarrhea. Gastroenterol Clin North Am. Use of stool collection kits delivered to patients can improve confirmation of etiology in foodborne disease outbreaks.

Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food—10 states, Guidelines on acute infectious diarrhea in adults.

Am J Gastroenterol. Hof H. History and epidemiology of listeriosis. Janakiraman V. Listeriosis in pregnancy: diagnosis, treatment, and prevention.

Rev Obstet Gynecol. Clinical practice. Acute infectious diarrhea. N Engl J Med. Ilnyckyj A. Clinical evaluation and management of acute infectious diarrhea in adults.

Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol. Evaluation and diagnosis of acute infectious diarrhea.

Diagnostic accuracy of stool assays for inflammatory bacterial gastroenteritis in developed and resource-poor countries. Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea.

World J Gastroenterol. To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea.

J Clin Microbiol. Lactoferrin in gastrointestinal disease. Intern Med. A cost effective and effective approach to the diagnosis and management of acute infectious diarrhea.

Bull N Y Acad Med. Hospitalizations involving gastroenteritis in the United States, the special burden of the disease among the elderly.

Am J Epidemiol. Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli OH7 and other enteropathogens.

Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults.

Guideline for the management of acute diarrhea in adults. J Gastroenterol Hepatol. Etiological agents of infectious diarrhea: implications for requests for microbial culture.

Vital signs: preventing Clostridium difficile infections. Inappropriate testing for diarrheal diseases in the hospital.

The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc. The value of rectosigmoidoscopy and the bacteriologic culture of colon biopsies in the etiologic diagnosis of acute diarrhea of adults.

A prospective study of 65 patients [in French]. Ann Gastroenterol Hepatol Paris. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review.

Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution.

Duggan C, Nurko S. J Pediatr. Gadewar S, Fasano A. Current concepts in the evaluation, diagnosis and management of acute infectious diarrhea.

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Work experience programs include internships, co-ops, practicums, clerkships, externships, residencies, clinical experiences, apprenticeships, and similar programs.

In , some 6 percent of noninstitutionalized to year-olds who were not enrolled in high school referred to as adults in this Fast Fact reported having a certification, 18 percent reported having a license, and 21 percent reported having completed a work experience program.

Percentage of to year-olds who have work credentials or have completed a work experience program, by highest level of education: NOTE: Survey respondents were noninstitutionalized to year-olds who were not enrolled in high school at the time of sampling although they could be enrolled in college.

Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial.

Ann Intern Med. Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler's diarrhea: a systematic review and meta-analysis.

Randomized, double-blind, placebo-controlled clinical trial of loperamide plus simethicone versus loperamide alone and simethicone alone in the treatment of acute diarrhea with gas-related abdominal discomfort.

Curr Med Res Opin. Adverse effect of lomotil therapy in shigellosis. Matheson AJ, Noble S. Antibiotic treatment for travellers' diarrhoea.

Cochrane Database Syst Rev. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli OH7 infections.

Management of infectious diarrhoea. Review article: the history of acute infectious diarrhoea management—from poorly focused empiricism to fluid therapy and modern pharmacotherapy.

Aliment Pharmacol Ther. Probiotics for treating acute infectious diarrhoea. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials.

Am J Clin Nutr. World Health Organization. The treatment of diarrhoea. A manual for physicians and other senior health workers.

Accessed October 1, Hand washing for preventing diarrhoea. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

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Acute Diarrhea in Adults. Author disclosure: No relevant financial affiliations. C 25 , 26 Testing for Clostridium difficile toxins A and B should be performed in patients who develop unexplained diarrhea after three days of hospitalization.

C 25 , 27 Routine testing for ova and parasites in acute diarrhea is not necessary in developed countries, unless the patient is in a high-risk group i.

C 11 , 29 The first step to treating acute diarrhea is rehydration, preferably oral rehydration. B 39 Antibiotics usually a quinolone reduce the duration and severity of traveler's diarrhea.

Noninflammatory vs. Inflammatory Diarrheal Syndromes Factor Noninflammatory Inflammatory Etiology Usually viral, but can be bacterial or parasitic Generally invasive or toxin-producing bacteria Pathophysiology More likely to promote intestinal secretion without significant disruption in the intestinal mucosa More likely to disrupt mucosal integrity, which may lead to tissue invasion and destruction History and examination findings Nausea, vomiting; normothermia; abdominal cramping; larger stool volume; nonbloody, watery stool Fever, abdominal pain, tenesmus, smaller stool volume, bloody stool Laboratory findings Absence of fecal leukocytes Presence of fecal leukocytes Common pathogens Enterotoxigenic Escherichia coli , Clostridium perfringens , Bacillus cereus , Staphylococcus aureus , Rotavirus , Norovirus , Giardia , Cryptosporidium , Vibrio cholerae Salmonella non-Typhi species , Shigella , Campylobacter , Shiga toxin—producing E.

Table 1. Table 2. Table 3. Algorithm for the treatment of acute diarrhea. Treatment of Acute Diarrhea Figure 1. Table 4. Read the full article.

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Sign up for the free AFP email table of contents. Navigate this Article. Usually viral, but can be bacterial or parasitic. Generally invasive or toxin-producing bacteria.

History and examination findings. Fever, abdominal pain, tenesmus, smaller stool volume, bloody stool.

Absence of fecal leukocytes. Presence of fecal leukocytes. Generally milder disease. Generally more severe disease. Severe fluid loss can still occur, especially in malnourished patients.

Afebrile, abdominal pain with bloody diarrhea. Shiga toxin—producing Escherichia coli. Camping, consumption of untreated water. Consumption of food commonly associated with foodborne illness.

Bacillus cereus. Exposure to day care centers. Fecal-oral sexual contact. Human immunodeficiency virus infection, immunosuppression.

Medical conditions associated with diarrhea. Medications or other therapies associated with diarrhea. Persistent diarrhea with weight loss. Recent antibiotic use.

Receptive anal intercourse, with or without rectal pain or proctitis. Herpes simplex virus infection, chlamydia, gonorrhea, syphilis.

Rectal pain or proctitis. Several persons with common food exposure have acute onset of symptoms. Food poisoning with preformed toxins.

Travel to a developing country. Clostridium difficile. Entamoeba histolytica. Proven in dysentery and sepsis, possibly effective in enteritis. Azithromycin Zithromax , mg once per day for 3 to 5 days.

Erythromycin, mg four times per day for 3 to 5 days. Consider prolonged treatment if the patient is immunocompromised.

Ciprofloxacin Cipro , mg twice per day for 5 to7 days. Metronidazole Flagyl , mg three times per day for 10 days. Vancomycin, mg four times per day for 10 days.

Ciprofloxacin, mg twice per day for 3 days. Azithromycin, mg per day for 3 days. Salmonella , non-Typhi species. Doubtful in enteritis; proven in severe infection, sepsis, or dysentery.

Azithromycin, mg per day for 5 to 7 days. Patients who are immunocompromised should be treated for 14 days. Antimotility agents should be avoided.

Ciprofloxacin, mg twice per day for 3 days, or 2-g single dose. This listing is subordered alphabetically by first name.

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Wikimedia list article. This is a dynamic list and may never be able to satisfy particular standards for completeness.

You can help by expanding it with reliably sourced entries. Candy Barr. Tamaki Katori. NOTE: Survey respondents were noninstitutionalized to year-olds who were not enrolled in high school at the time of sampling although they could be enrolled in college.

They do not include postsecondary degrees and certificates. Although rounded numbers are displayed, the figures are based on unrounded estimates.

In , the percentages of to year-olds with certifications, with licenses, and who had completed work experience programs were higher for those with a college degree referred to as college graduates than for those without a college degree referred to as non-college graduates.

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