What are the treatment options for diarrhea?

Treatment Options for Diarrhea

Oral rehydration therapy (ORT) is the cornerstone of treatment for diarrhea, with appropriate fluid and electrolyte replacement being the mainstay of management regardless of the causative organism. 1

Assessment of Dehydration

Before initiating treatment, assess the severity of dehydration:

• Mild to moderate dehydration: Irritability, decreased urine output, dry mucous membranes, increased thirst
• Severe dehydration: Altered mental status, tachycardia, hypotension, severely decreased skin turgor, serum osmolality >300 mOsm/kg 1

First-Line Treatment: Oral Rehydration

Oral Rehydration Solution (ORS)

• Use ORS containing 45-75 mEq/L sodium for mild to moderate dehydration 1
• Standard WHO formulation: 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water 1
• Commercial preparations are widely available and recommended

Administration Guidelines

• For mild dehydration: 50 mL/kg over 4 hours
• For moderate dehydration: 100 mL/kg over 4 hours
• Continue age-appropriate diet during or immediately after rehydration 1
• For children, breastfeeding should be continued throughout rehydration 1

Second-Line Treatment: Medications

Antimotility Agents

• Loperamide: First-line medication for adults with acute diarrhea 1
  • Initial dose: 4 mg followed by 2 mg after each loose stool
  • Maximum: 16 mg/day 2
  • Important safety warnings:
    • Contraindicated in children under 2 years due to risk of respiratory depression and cardiac adverse reactions 2
    • Avoid higher than recommended doses due to risk of cardiac events including QT prolongation 2
    • Use with caution in elderly patients or those taking medications that prolong QT interval 2

Dietary Management

• Continue regular diet or resume age-appropriate diet as soon as possible 1
• A bland/BRAT diet (Bananas, Rice, Applesauce, Toast) may be helpful 1
• Avoid spicy foods, coffee, alcohol, and foods high in simple sugars and fats 1
• For infants and young children, continue breastfeeding throughout the illness 3, 1

Special Considerations

When to Use Intravenous Fluids

• Severe dehydration (shock, altered mental status)
• Inability to tolerate oral fluids due to persistent vomiting
• Failure of oral rehydration therapy 1

Supplements

• Zinc supplementation is beneficial for children 6 months to 5 years with signs of malnutrition 1
• Probiotics may help reduce symptom duration and severity 1

When to Seek Medical Attention

• Bloody stools
• Persistent fever
• Signs of severe dehydration
• No improvement after 48 hours of treatment 1
• For children: decreased urination, lethargy, or irritability 3

Prevention

• Proper hand hygiene
• Food and water safety
• Appropriate infection control measures for contacts 1

Remember that while medications may provide symptomatic relief, rehydration remains the most critical intervention for managing diarrhea and preventing complications related to dehydration.