From the Guidelines
For diarrhea with fever, the primary treatment should focus on staying hydrated with oral rehydration solutions, such as Pedialyte or a homemade mixture, and managing fever with acetaminophen or ibuprofen, while avoiding anti-diarrheal medications like loperamide. The treatment approach should prioritize hydration and symptom management over antimicrobial therapy, unless a specific bacterial cause is identified [ 1 ].
Hydration and Symptom Management
- Oral rehydration solutions are recommended as the first-line therapy for mild to moderate dehydration in patients with acute diarrhea [ 1 ].
- Acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours can be used to manage fever, not exceeding the daily recommended dose [ 1 ].
- A bland diet consisting of bananas, rice, applesauce, and toast (BRAT diet) can help manage symptoms [ 1 ].
Antibiotic Therapy
- Antibiotics may be considered in specific cases, such as traveler's diarrhea, where the cause is suspected to be bacterial [ 1 ].
- Azithromycin, levofloxacin, ciprofloxacin, ofloxacin, and rifaximin are potential antibiotic options, with the choice depending on the suspected cause and geographic location [ 1 ].
When to Seek Medical Attention
- High fever (above 102°F/39°C), bloody stools, severe abdominal pain, signs of dehydration, or persistent symptoms beyond 3 days warrant medical attention [ 1 ].
By prioritizing hydration, symptom management, and judicious use of antibiotics, patients with diarrhea and fever can be effectively treated, reducing the risk of complications and improving outcomes [ 1 ].
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
Ciprofloxacin can be used to treat infectious diarrhea caused by certain bacteria, but it should only be used when antibacterial therapy is indicated.
- The presence of fever is not a direct contraindication, but the decision to use ciprofloxacin should be based on the suspected cause of the diarrhea and the severity of the symptoms.
- It is essential to note that ciprofloxacin is not a drug of first choice for all types of infections, and its use should be guided by culture and susceptibility testing whenever possible 2.
From the Research
Treatment for Diarrhea with Fever
- The treatment of acute diarrhea is still primarily supportive, with symptomatic therapy being the most important component 3.
- For severely ill patients with a high frequency of stools, fever, bloody diarrhea, underlying immune deficiency, advanced age, or significant comorbidities, empirical antibiotic therapy should be considered 3.
- Oral rehydration solutions (ORS) are effective for the management of diarrhea in both adults and children, and can be used for rehydration and maintenance therapy 4, 5.
- The use of a single solution for oral rehydration and maintenance therapy may be beneficial, as it can simplify treatment and reduce the risk of errors 5.
- For travelers' diarrhea, pretravel education on hygiene and safe food selection is important, and antibiotic use is not recommended for mild cases 6.
- For moderate to severe travelers' diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used, and loperamide may be considered as monotherapy or adjunctive therapy 6.
- In adults with acute diarrhea, management begins with replacing water, electrolytes, and nutrients, and oral rehydration is preferred unless there are signs of severe dehydration or sepsis 7.
- Antidiarrheal agents can be used as symptomatic therapy for acute watery diarrhea, and empiric antibiotics are rarely warranted except in cases of sepsis or inflammatory diarrhea 7.