What is the treatment for acute infectious diarrhea?

Treatment of Acute Infectious Diarrhea

Oral rehydration solution (ORS) is the cornerstone of treatment for acute infectious diarrhea, with antimicrobial therapy reserved only for specific pathogens and clinical scenarios. 1

Rehydration Therapy

Assessment of Dehydration

• Mild to Moderate Dehydration:

  • First-line: Reduced osmolarity oral rehydration solution (ORS)
  • Volume: Successful treatment typically requires 20-25 ml/kg of ORS intake 2
  • Administration: Oral or nasogastric route if patient cannot tolerate oral intake

• Severe Dehydration:

  • Isotonic IV fluids (lactated Ringer's or normal saline) until:
    • Pulse normalizes
    • Perfusion improves
    • Mental status normalizes
  • Then transition to ORS for remaining deficit

Maintenance Therapy

• Continue ORS to replace ongoing losses until diarrhea resolves
• Resume age-appropriate diet during or immediately after rehydration
• For infants: Continue breastfeeding throughout the diarrheal episode

Diet Management

• Early Feeding: Resume normal diet as soon as rehydration is complete
• No Fasting Period: Avoid traditional "bowel rest" approaches
• Breastfed Infants: Continue breastfeeding throughout illness

Antimicrobial Therapy

• General Rule: In most cases of acute watery diarrhea without recent international travel, antimicrobial therapy is NOT recommended 1

• Exceptions where antimicrobials may be indicated:

  1. Immunocompromised patients
  2. Ill-appearing young infants
  3. Specific pathogens:
     • Shigellosis
     • Cholera
     • Certain E. coli infections
     • Amebiasis and giardiasis (antiparasitic agents)

• Antimicrobial selection: Should be modified or discontinued when a specific pathogen is identified 1

Adjunctive Therapies

Antimotility Agents (e.g., Loperamide)

• Adults: May be given to immunocompetent adults with acute watery diarrhea 3
• Contraindications:
  • Children <18 years (absolutely contraindicated)
  • Inflammatory diarrhea or diarrhea with fever
  • Suspected or proven toxic megacolon

Antiemetics

• Ondansetron may be given to children >4 years and adolescents with vomiting to facilitate ORS tolerance

Probiotics

• May be offered to reduce symptom severity and duration in immunocompetent patients
• Evidence is moderate quality; specific recommendations for organisms and dosing should be based on literature review

Zinc Supplementation

• Beneficial for children 6 months to 5 years in areas with high zinc deficiency prevalence or with signs of malnutrition

Prevention Measures

• Hand hygiene after using toilet, changing diapers, before/after food preparation
• Appropriate food safety practices
• Infection control measures including gloves, gowns, and hand hygiene with soap and water or alcohol-based sanitizers

Common Pitfalls to Avoid

1. Unnecessary antimicrobial use - most cases are self-limiting viral infections
2. Delaying refeeding - early reintroduction of normal diet improves outcomes
3. Overreliance on antimotility agents - not a substitute for rehydration therapy
4. Inadequate fluid replacement - underestimating ongoing losses
5. Using antimotility agents in children - contraindicated under age 18

Remember that while most cases of acute infectious diarrhea are self-limiting, dehydration remains the primary cause of morbidity and mortality, making proper rehydration the most critical intervention.