What is the treatment for diarrhea?

Treatment for Diarrhea

The treatment for diarrhea should focus on oral rehydration therapy, early refeeding, and selective use of loperamide for adults, while antibiotics should be reserved only for specific indications such as dysentery, prolonged symptoms, or when specific pathogens are identified. 1, 2

Assessment and Evaluation

• Determine severity of diarrhea by assessing:

  • Signs of dehydration (dry mucous membranes, decreased skin turgor, sunken eyes)
  • Presence of blood in stool
  • Fever (especially if >38.5°C)
  • Duration of symptoms
  • Frequency of loose stools
  • Associated symptoms (vomiting, abdominal pain)

• Identify warning signs requiring medical attention:

  • Severe dehydration
  • Bloody diarrhea
  • High fever
  • Persistent symptoms >48 hours
  • Severe abdominal pain
  • Immunocompromised status

Treatment Algorithm

1. Rehydration (First Priority)

• For mild to moderate dehydration:

  • Maintain adequate fluid intake guided by thirst 1
  • Consume drinks containing glucose (lemonades, sweet sodas, fruit juices) or electrolyte-rich soups 1
  • For children and severe cases: Use oral rehydration solutions (ORS) containing 75-90 mEq/L sodium, 20 mEq/L potassium, 65-80 mEq/L chloride, and 75-111 mmol/L glucose 2

• For severe dehydration:

  • Seek medical attention for possible IV fluid administration 2

2. Diet Management

• Continue eating based on appetite
• Consume small, light meals
• Recommended foods: starches, cereals, yogurt, fruits, and vegetables 1
• Avoid:
  • Foods high in simple sugars and fats
  • Fatty, heavy, or spicy foods
  • Caffeine-containing drinks
  • Lactose-containing foods (especially in prolonged episodes) 1

3. Medication Options

For Adults (>12 years):

• Antidiarrheal medication:

  • Loperamide 2 mg (flexible dosing according to loose bowel movements) is the drug of choice 1
  • Important safety warning: Avoid higher than recommended doses due to risk of cardiac adverse reactions including QT prolongation, Torsades de Pointes, and sudden death 3
  • Contraindicated in:
    • Children under 2 years
    • Patients with bloody diarrhea
    • Patients taking QT-prolonging medications
    • Patients with risk factors for QT prolongation 3

• Antibiotics:

  • Not routinely recommended for acute diarrhea 1
  • Consider only when:
    • Dysentery (high fever and blood in stool) is present
    • Watery diarrhea persists >5 days
    • Specific pathogens requiring treatment are identified 1
  • For travelers' diarrhea: quinolones are recommended, with cotrimoxazole as second choice 1

For Children:

• Loperamide is contraindicated in children under 2 years 3
• Use with special caution in children under 6 years due to greater variability of response 3
• Focus on rehydration and early refeeding 1, 2

Special Considerations

• Dehydration risk: Fluid and electrolyte depletion often occur with diarrhea; appropriate fluid and electrolyte therapy is essential even when using antidiarrheal medications 3

• When to seek medical attention:

  • No improvement within 48 hours
  • Worsening symptoms
  • Development of warning signs (severe vomiting, dehydration, persistent fever, abdominal distension, blood in stool) 1

• Contraindications for loperamide:

  • When inhibition of peristalsis should be avoided
  • At first signs of abdominal distention or ileus
  • In AIDS patients with infectious colitis at earliest signs of abdominal distention 3

Prevention

• Proper handwashing after toilet use and before food preparation
• Safe food preparation
• Access to clean water 2

Remember that most cases of acute diarrhea are self-limiting viral infections that resolve within a few days with proper hydration and supportive care 4, 5.