From the Guidelines
The primary treatment for acute diarrhea is oral rehydration therapy, which should be initiated immediately to prevent dehydration and replace lost fluids and electrolytes. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, ancillary treatment with antimotility, antinausea, or antiemetic agents can be considered once the patient is adequately hydrated.
- For adults with acute watery diarrhea, loperamide may be given to reduce bowel movements and fluid loss, but it should be avoided in cases of suspected or proven toxic megacolon, inflammatory diarrhea, or diarrhea with fever 1.
- Antinausea and antiemetic agents, such as ondansetron, may be given to facilitate tolerance of oral rehydration in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting 1.
- The use of oral rehydration solutions (ORS) is recommended as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
- Patients should be advised to eat small, frequent meals of easily digestible foods, such as bananas, rice, toast, and applesauce (BRAT diet), and avoid dairy, fatty, or spicy foods until recovery.
- Probiotics, such as Lactobacillus or Saccharomyces boulardii, can help restore gut flora and may shorten the duration of diarrhea, but their use should be guided by the patient's overall clinical condition and medical history 1.
- Most cases of acute diarrhea are self-limiting and resolve within 3-5 days, but if symptoms persist beyond a week, or if the patient experiences severe abdominal pain, high fever, or bloody stools, medical attention should be sought as antibiotics may be necessary 1.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Dehydration, particularly in pediatric patients less than 6 years of age, may further influence the variability of response to loperamide hydrochloride. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy
The treatment plan for acute diarrhea includes:
- Symptomatic relief with loperamide hydrochloride capsules for patients 2 years of age and older
- Fluid and electrolyte therapy to prevent dehydration
- Specific treatment for the underlying cause of diarrhea, if determined
- Monitoring for signs of abdominal distention, constipation, or ileus, and discontinuing loperamide hydrochloride if these occur 2, 2
From the Research
Treatment Plan for Acute Diarrhea
The treatment plan for acute diarrhea involves several key components, including:
- Rehydration therapy: Oral rehydration therapy is the primary treatment for acute diarrhea, and is effective for treating dehydration of any severity 3, 4, 5, 6, 7.
- Assessment of dehydration: The degree of dehydration should be assessed clinically, following WHO guidelines 5.
- Oral rehydration solutions: The WHO-recommended oral rehydration solution is widely available and effective, but newer formulations using starches, cereals, and/or amino acids may be even more efficacious 3.
- Intravenous fluids: Intravenous fluids, such as Ringer's lactate, may be necessary for severe dehydration 4.
- Feeding during diarrhea: Early reintroduction of milk, formula, or solid food is important to prevent malnutrition and growth retardation 5, 6, 7.
- Antibiotic therapy: Antibiotics are only recommended for specific cases, such as severe cholera or bloody diarrhea (presumably shigellosis) 4, 5, 6.
- Micronutrient supplementation: Zinc supplementation during diarrhea may reduce the severity and duration of the disease 5.
- Probiotics: Probiotics may offer a safe intervention to reduce the duration and severity of acute infectious diarrhea 5.