From the Guidelines
The workup for acute diarrhea should begin with a thorough history and physical examination to determine severity and likely etiology, with oral loperamide being the treatment of choice for relieving symptoms in otherwise healthy adults. According to the guidelines for adults on self-medication for the treatment of acute diarrhoea 1, self-medication in otherwise healthy adults is safe and oral loperamide is the preferred treatment. The treatment goals are to relieve discomfort and social dysfunction, without prolonging the illness.
For adults, the recommended treatment is oral loperamide, which can help reduce symptoms 1. Medical intervention is recommended for the management of acute diarrhoea in specific groups, including the frail, the elderly (> 75 years), persons with concurrent chronic disease, and children, as well as when there is no abatement of symptoms after 48 h, or evidence of deterioration such as dehydration, abdominal distension, or the onset of dysentery 1.
Key considerations in the workup for acute diarrhea include:
- Determining the severity and likely etiology of the diarrhea
- Assessing the need for medical intervention based on patient characteristics and symptoms
- Using oral loperamide as the treatment of choice for relieving symptoms in otherwise healthy adults
- Considering laboratory testing, such as stool studies, for severe cases or those with concerning features
- Providing supportive care with oral rehydration and monitoring for signs of severe dehydration or other complications.
From the FDA Drug Label
Patients should receive appropriate fluid and electrolyte replacement as needed Acute Diarrhea Adults and Pediatric Patients 13 Years and Older: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool. Pediatric Patients 2 Years to 12 Years of Age: In pediatric patients 2 years to 5 years of age (20 kg or less), the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) should be used; for ages 6 to 12, either loperamide hydrochloride capsules or Imodium A-D liquid may be used The work up for acute diarrhea includes:
- Fluid and electrolyte replacement as needed
- Loperamide dosing:
- Adults and pediatric patients 13 years and older: 4 mg initial dose, followed by 2 mg after each unformed stool
- Pediatric patients 2-12 years: dose varies by age and weight, with a maximum daily dose not to exceed recommended dosages for the first day 2
From the Research
Workup for Acute Diarrhea
- The workup for acute diarrhea should start with a thorough history and physical examination to assess the severity of the illness and determine if investigations are needed 3, 4, 5, 6.
- Most episodes of acute diarrhea are self-limited and do not require specific therapy or diagnostic workup 3, 4, 5, 6.
- Diagnostic investigation should be reserved for patients with:
Laboratory Tests
- Routine stool cultures are not recommended for most patients with acute diarrhea 4, 6.
- Molecular studies are preferred over traditional stool cultures unless an outbreak is suspected 6.
- Laboratory tests should be guided by the patient's clinical presentation and risk factors 3, 4, 5, 6.
Treatment
- Treatment for acute diarrhea should focus on preventing and treating dehydration 3, 4, 5, 6.
- Oral rehydration therapy with early refeeding is the preferred treatment for dehydration 4, 5, 6.
- Antimotility agents can be useful in reducing the number of bowel movements and diminishing the magnitude of fluid loss, but should be avoided in patients with bloody diarrhea 3, 4, 7.
- Antibiotic therapy is not required in most patients with acute diarrheal disorders, but may be indicated in certain cases such as shigellosis, campylobacteriosis, or Clostridium difficile infection 3, 4, 7, 6.