What is the treatment for explicit diarrhea?

Treatment of Acute Diarrhea

The primary treatment for acute diarrhea consists of oral rehydration therapy (ORT), continued feeding, and possibly loperamide for watery diarrhea in immunocompetent individuals over 12 years of age. 1

Assessment and Initial Management

Rehydration

• Oral Rehydration Solution (ORS) is the first-line therapy for mild to moderate dehydration 2, 1
  • For adults with mild-moderate dehydration: Use reduced osmolarity ORS
  • For severe dehydration: Administer isotonic intravenous fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 2
  • Once IV rehydration is complete, switch to ORS to replace remaining deficit 2

Fluid Intake for Adults

• Maintain adequate fluid intake as indicated by thirst 2
• Recommended fluids:
  • Drinks containing glucose (lemonades, sweet sodas, fruit juices)
  • Electrolyte-rich soups 2
• Note: Unlike in children, ORS is not essential for otherwise healthy adults with diarrhea 2

Medication Options

Antimotility Agents

• Loperamide (2 mg, flexible dose according to loose bowel movements) is the drug of choice for watery diarrhea in adults and adolescents over 12 years 2, 1
• Contraindications for loperamide:
  • Dysentery (high fever >38.5°C and/or bloody stools)
  • Children under 12 years 2, 1
  • Immunocompromised patients with inflammatory diarrhea 1

Antimicrobials

• Not recommended for routine treatment of uncomplicated, watery diarrhea 2
• Specific indications for antimicrobial use:
  • Cholera
  • Shigella dysentery
  • Amoebic dysentery
  • Acute giardiasis
  • Clostridium difficile infection (oral vancomycin 125 mg four times daily for 10 days) 3
  • Moderate to severe traveler's diarrhea (quinolones preferred, cotrimoxazole as second choice) 2

Other Medications

• Ondansetron may be given if vomiting is present to facilitate oral rehydration 1
• Probiotics may be considered to reduce symptom severity and duration 1, 4
• Anti-diarrheal agents other than loperamide are not recommended due to uncertain efficacy or potential side effects 2

Dietary Management

Food Intake

• Consumption of solid food should be guided by appetite 2
• Resume age-appropriate usual diet during or immediately after rehydration 2
• Recommended foods: small light meals, starches, cereals, yogurt, fruits, and vegetables 2, 1
• Avoid:
  • Fatty, heavy, spicy foods
  • Caffeine (including cola drinks)
  • Lactose-containing foods (milk) may worsen prolonged episodes 2

Breastfeeding

• Human milk feeding should be continued in infants throughout the diarrheal episode 2

When to Seek Medical Attention

Patients should seek medical advice if:

• No improvement is seen in 48 hours
• Symptoms worsen or overall condition deteriorates
• Warning signs develop:
  • Severe vomiting or dehydration
  • Persistent fever
  • Abdominal distension
  • Frank blood in stools 2
  • Altered mental status 1

Special Considerations

Traveler's Diarrhea

• Empirical self-medication with antimicrobials may be justified during travel abroad 2
• Quinolones are the first-line antimicrobials for traveler's diarrhea, with cotrimoxazole as second choice 2
• Loperamide can be safely combined with antimicrobials to hasten remission in non-dysenteric diarrhea and mild febrile dysentery 2

Clostridium difficile Infection

• Oral vancomycin (125 mg four times daily for 10 days) is effective for C. difficile-associated diarrhea 3
• Clinical success rates of approximately 81% can be expected 3
• Median time to resolution of diarrhea is 4-5 days 3

Prevention

• Hand hygiene is crucial after using the toilet, before and after preparing food 1
• Safe food preparation and access to clean water are essential preventive measures 4

By following this treatment algorithm, most cases of acute diarrhea will resolve quickly with minimal complications. The focus should remain on preventing dehydration while allowing the body to naturally clear the infection in most cases.