From the Guidelines
Persistent diarrhea, lasting more than 2-4 weeks, requires immediate medical attention to identify and treat the underlying cause, as it can lead to severe complications such as dehydration, malnutrition, and even death, as highlighted in the 2017 IDSA guidelines for the diagnosis and management of infectious diarrhea 1. To manage persistent diarrhea, it is essential to start with oral rehydration solutions like Pedialyte or a homemade mixture (1 liter of water with 6 teaspoons of sugar and 1/2 teaspoon of salt) to prevent dehydration. Some key points to consider in the management of persistent diarrhea include:
- Over-the-counter medications like loperamide (Imodium) at 2mg after each loose stool (maximum 8mg/day) can provide temporary relief but shouldn't be used if you have fever or bloody stools.
- Probiotics such as Lactobacillus GG or Saccharomyces boulardii may help restore gut flora.
- Follow the BRAT diet (bananas, rice, applesauce, toast) and avoid dairy, caffeine, alcohol, and fatty foods.
- Seek immediate medical care if you experience severe abdominal pain, high fever, bloody stools, or signs of dehydration like extreme thirst or dizziness. The underlying causes of persistent diarrhea can be diverse, including infections, inflammatory bowel disease, medication side effects, or food intolerances, as outlined in the guidelines for the investigation of chronic diarrhoea 1. Some of the potential causes of persistent diarrhea include:
- Colonic neoplasia
- Ulcerative and Crohn’s colitis
- Microscopic colitis
- Coeliac disease
- Crohn’s disease
- Bile acid malabsorption
- Disaccharidase deficiency
- Small bowel bacterial overgrowth
- Chronic pancreatitis
- Pancreatic carcinoma
- Hyperthyroidism
- Diabetes
- Hormone secreting tumours (VIPoma, gastrinoma, carcinoid)
- Factitious diarrhoea
- Drugs
- Alcohol
- Autonomic neuropathy Proper diagnosis is essential for effective treatment, and without addressing the underlying cause, symptoms may continue or worsen, potentially leading to nutritional deficiencies and other complications, as emphasized in the 2017 IDSA guidelines 1.
From the FDA Drug Label
Pseudomembranous Colitis: Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg, and may range in severity from mild diarrhea to fatal colitis.
that diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic
Persistent Diarrhea is a possible side effect of ciprofloxacin, and it can be caused by Clostridium difficile associated diarrhea (CDAD). Patients should be monitored for signs of diarrhea, and if it occurs, they should contact their physician as soon as possible.
- Diarrhea can range from mild to fatal colitis
- CDAD can occur even after the antibiotic is discontinued, up to two or more months after the last dose
- Patients should be advised to seek medical attention if they experience watery and bloody stools, stomach cramps, or fever 2 2
From the Research
Definition and Causes of Persistent Diarrhea
- Persistent diarrhea is defined as diarrhea that lasts for 14 days or more 3
- It can be caused by various pathogens, including parasitic, bacterial, and viral infections 3
- The causes of persistent diarrhea can differ from those of acute diarrhea, and proper etiologic diagnosis is important for appropriate therapeutic management 3
Diagnosis of Persistent Diarrhea
- Available diagnostic tests include culture-dependent methods for bacterial pathogens and culture-independent methods for bacterial, viral, and protozoal infections 3
- Microscopy for protozoal infections and multiplex PCR can also be used for diagnosis 3
- A thorough history and physical exam can help identify the underlying cause of persistent diarrhea 4
Treatment of Persistent Diarrhea
- Antimicrobial therapy can be given empirically to patients returning from undeveloped to developed countries 3
- Otherwise, antibiotics should be given based on the results of laboratory testing 3
- Probiotics, such as Lactobacillus GG and Saccharomyces boulardii, have been shown to be effective in preventing and treating diarrhea 5, 6, 7
Management of Chronic Diarrhea
- Chronic diarrhea is defined as diarrhea that lasts for more than 4 weeks 4
- It can be caused by a variety of factors, including inflammatory, neoplastic, malabsorptive, infective, vascular, and functional gastrointestinal diseases 4
- Treatment options for chronic diarrhea depend on the underlying cause and may include antimicrobial therapy, probiotics, and other medications 4