What is the recommended treatment for diarrhea?

From the Guidelines

The recommended treatment for diarrhea includes staying hydrated with water, clear broths, and oral rehydration solutions like Pedialyte to replace lost fluids and electrolytes, as stated in the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. For mild cases, dietary adjustments such as following the BRAT diet (bananas, rice, applesauce, toast) and avoiding dairy, fatty, spicy foods, caffeine, and alcohol can help. Some key points to consider in the treatment of diarrhea include:

• The use of reduced osmolarity oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
• The administration of ORS according to the degree of dehydration, with specific recommendations for infants, children, and adults 1.
• The consideration of nasogastric administration of ORS in infants, children, and adults with moderate dehydration who cannot tolerate oral intake 1.
• The use of isotonic intravenous fluids such as lactated Ringer’s and normal saline solution in cases of severe dehydration, shock, or altered mental status and failure of ORS therapy 1.
• The importance of maintaining hydration and replacing ongoing losses in stools with ORS until diarrhea and vomiting are resolved 1.
• The potential use of antimotility agents like loperamide in immunocompetent adults with acute watery diarrhea, but with caution and avoidance in certain situations such as suspected or proven cases of toxic megacolon or inflammatory diarrhea with fever 1.
• The consideration of probiotics such as Lactobacillus or Saccharomyces boulardii to help restore gut flora, although evidence may vary 1. It is essential to note that most cases of diarrhea are self-limiting and resolve within 2-3 days, but medical attention is necessary for severe symptoms like high fever, bloody stools, severe abdominal pain, signs of dehydration, or if diarrhea persists beyond 3 days 1. In specific populations, such as adult cancer patients, guidelines may recommend different approaches, including the use of oral rehydration therapy, loperamide, and other medications like octreotide or uridine triacetate, depending on the severity and cause of diarrhea 1. Overall, the treatment of diarrhea should prioritize hydration, electrolyte replacement, and symptom management, with consideration of the underlying cause and individual patient factors.

From the FDA Drug Label

Dehydration Fluid and electrolyte depletion often occur in patients who have diarrhea In such cases, administration of appropriate fluid and electrolytes is very important. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy 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 diarrhea includes:

• Administration of appropriate fluid and electrolytes to prevent dehydration
• Symptomatic treatment with loperamide hydrochloride
• Specific treatment of the underlying etiology when determined 2

From the Research

Diarrhea Treatment

• The recommended treatment for diarrhea involves the use of oral rehydration solutions (ORS) to replace lost fluids and electrolytes 3, 4.
• ORS typically contains a combination of sodium, potassium, and glucose, with the World Health Organization (WHO) recommending a specific formulation of 90 mmol/L of sodium, 20 mmol/L of potassium, 111 mmol/L of glucose, and 10 mmol/L of citrate 4.
• For patients with mild to moderate dehydration, ORS is the preferred treatment, while those with severe dehydration may require intravenous fluids initially, followed by ORS 5.
• The use of other liquids, such as sports drinks, juice, and soft drinks, is not recommended for rehydration, although they may be considered for patients with no or mild dehydration 3.
• In addition to ORS, maintaining hydration during and after diarrhea is crucial, with recommendations to consume fluids and sodium-containing snacks or foods to replace lost electrolytes 3, 5.

Oral Rehydration Therapy (ORT)

• ORT has been recognized as a highly effective treatment for acute diarrheal disease, with the potential to save millions of lives worldwide 4, 6.
• The use of ORT has been shown to reduce the duration and severity of diarrhea, as well as the risk of dehydration and related complications 4, 6.
• Despite its proven effectiveness, ORT is often underused in developed countries, with healthcare providers preferring intravenous hydration and other treatments 6.
• Education and training of healthcare providers on the proper use of ORT are essential to improve treatment outcomes and reduce the burden of diarrheal disease 6.

Special Considerations

• For children with diarrhea, ORT is recommended as the first line of treatment, with intravenous fluids reserved for those with severe dehydration or other complications 5, 6.
• The use of ORS with reduced osmolarity has been shown to be effective in reducing the duration and severity of diarrhea in children 4.
• In cases of severe dehydration, the use of intravenous fluids with added potassium and sodium may be necessary to restore electrolyte balance and prevent complications 5.