What is the recommended treatment for diarrhea?

Treatment of Diarrhea

The primary recommended treatment for diarrhea is oral rehydration therapy using reduced osmolarity oral rehydration solution (ORS) as first-line therapy for mild to moderate dehydration, with appropriate fluid and electrolyte replacement being the cornerstone of management. 1

Initial Assessment and Management

• Rehydration therapy should be the first priority in managing diarrhea, with the approach determined by severity of dehydration 1:

  • Mild to moderate dehydration: Reduced osmolarity ORS is the first-line therapy 1
  • Severe dehydration: Isotonic intravenous fluids (lactated Ringer's or normal saline) should be administered 1

• For adults with mild to moderate dehydration, maintain adequate fluid intake as indicated by thirst, using drinks containing glucose (lemonades, sweet sodas, fruit juices) or electrolyte-rich soups 1

• For severe dehydration, intravenous rehydration should continue until pulse, perfusion, and mental status normalize 1

Specific Treatment Approaches

Dietary Management

• Resume age-appropriate usual diet during or immediately after rehydration 1
• Human milk feeding should be continued in infants and children throughout the diarrheal episode 1
• Small, light meals are recommended for adults, avoiding fatty, heavy, spicy or stimulant foods 1
• Avoidance of lactose-containing foods may be helpful in more prolonged episodes 1

Pharmacological Management

• Antimotility agents:

  • Loperamide (2 mg, flexible dosing based on loose bowel movements) may be given to immunocompetent adults with acute watery diarrhea 1
  • Loperamide should NOT be given to children <18 years of age with acute diarrhea 1
  • Loperamide should be avoided in patients with bloody diarrhea, fever, or suspected inflammatory diarrhea 1, 2
  • Cardiac adverse reactions including QT prolongation have been reported with higher than recommended doses 2

• Antiemetics:

  • Ondansetron may be given to facilitate oral rehydration in children >4 years and adolescents with vomiting 1

• Probiotics:

  • May be offered to reduce symptom severity and duration in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea 1

• Zinc supplementation:

  • Reduces duration of diarrhea in children 6 months to 5 years of age who reside in countries with high zinc deficiency prevalence or show signs of malnutrition 1

Special Considerations

• Antimicrobial therapy should be modified or discontinued when a clinically plausible organism is identified 1

• In most people with acute watery diarrhea without recent international travel, empiric antimicrobial therapy is not recommended 1

• For cancer patients with diarrhea, additional options include octreotide for persistent grade 2 or higher diarrhea 1

When to Seek Medical Care

Patients should seek medical advice if 1:

• No improvement is seen within 48 hours
• Symptoms worsen or overall condition deteriorates
• Warning signs develop (severe vomiting, dehydration, persistent fever, abdominal distension, or blood in stools)

Prevention Measures

• Hand hygiene should be performed after using the toilet, before and after preparing food, before eating, and after handling potentially contaminated items 1

• Asymptomatic contacts of people with acute or persistent watery diarrhea should not receive empiric or preventive therapy but should follow appropriate infection prevention measures 1