From the Guidelines
The recommended treatment for viral intestinal diarrhea primarily focuses on supportive care and hydration, with oral rehydration therapy as the cornerstone of treatment, using solutions like Pedialyte, Gatorade, or homemade mixtures, as stated in the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The treatment approach should prioritize the replacement of essential fluids and electrolytes lost through diarrhea, preventing complications like dehydration, while the body's immune system naturally fights the viral infection. Key aspects of treatment include:
- Oral rehydration therapy, with adults consuming 2-3 liters daily, and children needing 1 ml of fluid per gram of stool output.
- Anti-diarrheal medications like loperamide (Imodium) can provide symptomatic relief in adults but should be avoided in children and those with bloody diarrhea or high fever, as recommended by the 2017 guidelines 1.
- Probiotics such as Lactobacillus or Saccharomyces boulardii may help reduce the duration of symptoms, as suggested by the 2017 guidelines 1.
- A bland diet including bananas, rice, applesauce, and toast (BRAT diet) can be tolerated during recovery. Most viral diarrhea is self-limiting and resolves within 2-5 days. Medical attention should be sought if symptoms persist beyond 3-4 days, if there's severe dehydration (decreased urination, extreme thirst, dizziness), bloody stools, or high fever, as advised in the guidelines 1.
From the FDA Drug Label
Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).
The recommended treatment for viral intestinal diarrhea is symptomatic treatment. Loperamide hydrochloride can be used to treat the symptoms of diarrhea, but it is essential to determine the underlying cause of the diarrhea and provide specific treatment when appropriate.
- Fluid and electrolyte replacement is crucial in patients with diarrhea to prevent dehydration.
- Loperamide hydrochloride can be used to treat the symptoms of diarrhea, but it is not a substitute for specific treatment of the underlying cause. 2
From the Research
Treatment Options for Viral Intestinal Diarrhea
- The treatment for viral intestinal diarrhea is primarily supportive, with a focus on managing symptoms and preventing dehydration 3, 4, 5.
- Oral rehydration solutions (ORS) are recommended to help replace lost fluids and electrolytes 3, 4.
- Zinc supplementation has been shown to be effective in reducing the duration and severity of diarrhea in children 4.
- Probiotics and racecadotril may also be beneficial in certain cases, although more research is needed to confirm their efficacy 4.
- Antibiotics are not typically recommended for viral intestinal diarrhea, as they are ineffective against viral infections and can contribute to antibiotic resistance 6, 5.
Specific Considerations
- In cases of severe dehydration, bloody diarrhea, or immunosuppression, more aggressive treatment may be necessary, including hospitalization and antibiotic therapy 6, 5.
- Loperamide may be used to reduce the frequency and duration of diarrhea in immunocompetent adults with acute infectious diarrhea, but its use should be cautious in patients with dysentery or severe comorbidities 7.
- Fecal microbiota transplantation may be considered for patients with recurrent Clostridium difficile infections 6.
General Principles
- The management of viral intestinal diarrhea should be tailored to the individual patient's needs and circumstances, taking into account factors such as age, immune status, and severity of symptoms 4, 5.
- Public health and epidemiological considerations should also be taken into account, particularly in cases of suspected outbreaks or nosocomial infections 5.