What is the management of diarrhea in adults?

Management of Diarrhea in Adults

The management of acute diarrhea in adults should focus on rehydration, symptomatic relief with antimotility agents like loperamide, and appropriate diet, with antibiotics reserved for specific cases. 1

Assessment and Triage

• Determine severity of diarrhea and presence of warning signs that require medical attention: high fever (>38.5°C), bloody stools, severe vomiting, obvious dehydration, or altered mental status 1
• Assess for dehydration by evaluating mental status, pulse, skin turgor, and mucous membranes 1
• Self-medication is appropriate for otherwise healthy adults with uncomplicated acute diarrhea, but medical supervision is recommended for those with significant systemic illnesses, the frail elderly (>75 years), or those with recurrent diarrhea due to chronic bowel disease 1

Rehydration Therapy

• For mild to moderate dehydration in adults, oral rehydration is the preferred method 1
• For otherwise healthy adults, maintain adequate fluid intake as indicated by thirst using glucose-containing drinks (lemonades, sweet sodas, fruit juices) or electrolyte-rich soups 1
• Formal oral rehydration solutions (ORS), while essential in infantile diarrhea, are generally not needed for otherwise healthy adult sufferers 1
• For severe dehydration, shock, or altered mental status, administer isotonic intravenous fluids such as lactated Ringer's or normal saline until pulse, perfusion, and mental status normalize 1
• Avoid popular beverages like apple juice, Gatorade, and commercial soft drinks for rehydration purposes 1

Dietary Management

• Continue food intake guided by appetite; there is no evidence in adults that fasting or specific dieting is beneficial 1
• Resume an age-appropriate usual diet during or immediately after rehydration 1
• Recommend small, light meals and avoid fatty, heavy, spicy foods and caffeine 1
• Consider avoiding lactose-containing foods (such as milk) in more prolonged episodes of diarrhea 1

Pharmacological Management

Antimotility Agents

• Loperamide is the drug of choice for adults with acute watery diarrhea (2 mg with flexible dosing according to loose bowel movements) 1, 2
• Loperamide should not be given to children under 18 years of age with acute diarrhea 1
• Avoid antimotility drugs in cases of suspected or proven inflammatory diarrhea, diarrhea with fever, or bloody stools 1

Other Medications

• Bismuth subsalicylate can be used for symptomatic relief (2 tablets every 30 minutes to 1 hour as needed, not exceeding 8 doses in 24 hours) 3
• Antinausea and antiemetic agents (e.g., ondansetron) may be given to facilitate tolerance of oral rehydration in adults with vomiting 1
• Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent adults 1, 4

Antibiotics

• Antibiotics are not generally recommended for uncomplicated acute diarrhea in adults 1, 4
• Consider empirical antibiotic therapy for:
  • Moderate to severe traveler's diarrhea 1, 5
  • Diarrhea with fever and/or bloody stools 1, 5
  • Known bacterial pathogens requiring treatment 1, 5
• Quinolones (such as ciprofloxacin or levofloxacin) are first-line antibiotics for empirical treatment when indicated, with cotrimoxazole as second choice 1, 5

When to Seek Medical Attention

• No improvement within 48 hours 1
• Worsening symptoms or overall condition 1
• Development of warning signs: severe vomiting, dehydration, persistent fever, abdominal distension, or blood in stools 1
• Immunocompromised status 4, 6
• Suspected nosocomial infection or outbreak 4, 6

Prevention

• Practice proper hand hygiene after using the toilet, changing diapers, before and after preparing food, before eating, and after handling garbage or soiled items 1
• Follow infection control measures including use of gloves and gowns when caring for people with diarrhea 1
• Safe food preparation and access to clean water 4