From the Guidelines
The treatment for diarrhea should focus on oral rehydration therapy and symptom management, with loperamide being the treatment of choice for adults, as it is safe and effective in relieving symptoms. According to the most recent and highest quality study 1, oral rehydration therapy (ORT) is generally appropriate for mild diarrhea, and oral rehydration solutions (ORS) may be more appropriate in patients with more severe diarrheal disease.
For mild cases, drinking clear fluids like water, broth, or diluted fruit juices is recommended. Over-the-counter medications such as loperamide (Imodium) can be used to reduce frequency of bowel movements, with an initial dose of 4 mg followed by 2 mg every 2–4 h or after every unformed stool, and a maximum daily dose of 16 mg 1.
Some key points to consider in the treatment of diarrhea include:
- Oral rehydration therapy is the cornerstone of treatment
- Loperamide is the treatment of choice for adults
- Avoid dairy, caffeine, alcohol, and fatty or spicy foods until recovered
- If diarrhea is severe, contains blood, lasts longer than 2 days, or is accompanied by fever, seek medical attention as antibiotics or other treatments may be needed
It's also important to note that medical intervention is recommended for the management of acute diarrhea in certain groups, such as the frail, the elderly, persons with concurrent chronic disease, and children, as well as when there is no abatement of symptoms after 48 h, or when there is evidence of deterioration 1.
In terms of specific treatments, loperamide can be started at an initial dose of 4 mg followed by 2 mg every 2–4 h or after every unformed stool, and the maximum daily dose of loperamide is 16 mg 1. Other treatments, such as octreotide and uridine triacetate, may also be used in certain cases 1.
Overall, the goal of treatment is to prevent dehydration, manage symptoms, and restore normal gut function, while also considering the individual patient's needs and circumstances.
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 treatment for diarrhea with loperamide hydrochloride is symptomatic. It is important to determine the underlying etiology of the diarrhea and provide specific treatment when appropriate. Additionally, fluid and electrolyte therapy is important in patients with diarrhea to prevent dehydration. 2
- Loperamide hydrochloride is used to treat diarrhea symptoms.
- Fluid and electrolyte replacement is necessary to prevent dehydration.
- Specific treatment for the underlying cause of diarrhea should be given when possible.
From the Research
Treatment for Diarrhea
The treatment for diarrhea typically involves a combination of the following:
- Oral rehydration therapy (ORT) to replace lost fluids and electrolytes 3, 4
- Probiotics to help reduce the duration and severity of diarrhea 5, 6, 7
- Dietary changes, such as early reintroduction of milk, formula, or solid food 4
Oral Rehydration Therapy
Oral rehydration solutions can be used safely for the treatment of mild acute diarrhea, with solutions containing 90,50, or 30 mmol/L of sodium being effective 3. Citrate is as efficacious as bicarbonate in the correction of acidosis 3.
Probiotics
Probiotics, such as Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii, have been shown to be effective in reducing the duration of diarrhea by 1 day 6. They may also be useful in preventing antibiotic-associated diarrhea (AAD) and necrotizing enterocolitis (NEC) 6. However, the beneficial effects of probiotics may be limited to prophylactic usage in high-risk populations 5.
Dietary Changes
Early reintroduction of milk, formula, or solid food is important in the treatment of diarrhea, as is instruction of parents in measures to minimize transmission of infectious agents 4.
Other Considerations
Antibiotic and antidiarrheal agents are usually not indicated in the treatment of diarrhea 4. Intravenous rehydration may be necessary for children who are in shock or unable to drink 4.