What are the treatment and management expectations for a patient with acute diarrheal illness?

Communicating Expectations for Acute Diarrheal Illness to Patients

Most acute diarrheal illnesses resolve on their own within a few days without any specific treatment, and the most important thing you need to do is stay hydrated by drinking plenty of fluids at home. 1

What to Expect

Timeline and Natural Course

• Your diarrhea will likely improve within 2-3 days and should be completely resolved within 5-7 days in most cases 2, 3
• The illness is self-limited, meaning your body will fight it off naturally without antibiotics 1, 2
• You may experience 3-10 loose or watery stools per day during the acute phase 3

Common Accompanying Symptoms

• You may also experience nausea, vomiting, abdominal cramping, and low-grade fever 2, 3
• These symptoms typically improve along with the diarrhea 4
• Fatigue and decreased appetite are normal and should gradually improve 2

Home Management: What You Need to Do

Hydration is Your Priority

The single most important treatment is replacing the fluids and electrolytes you're losing through diarrhea and vomiting. 1

• Drink oral rehydration solutions (ORS) like Pedialyte, CeraLyte, or Enfalac Lytren—these are specifically designed to replace what you're losing 1
• Avoid plain water alone, as it doesn't contain the necessary electrolytes 1
• Do NOT use sports drinks like Gatorade, apple juice, or soft drinks for rehydration—they have the wrong balance of sugars and salts 1

How Much to Drink

• Replace each loose stool: Drink approximately 1-2 cups (240-480 mL) of ORS after each diarrheal episode 1
• Replace vomiting episodes: Drink about ¼ cup (60 mL) of ORS after each vomiting episode 1
• Continue drinking ORS throughout the day, aiming for up to 2 liters daily if needed 1

Eating During Illness

• Continue eating as soon as you can tolerate food—you don't need to wait for diarrhea to stop 1
• Resume your normal diet during or immediately after rehydration 1
• Good food choices include starches, cereals, yogurt, fruits, and vegetables 5
• Avoid foods high in simple sugars and fats temporarily 5

Medications: What to Avoid and What May Help

Antimotility Medications (Like Imodium/Loperamide)

• You may use loperamide (Imodium) if you have watery diarrhea without fever or blood to reduce stool frequency 1
• Absolutely DO NOT use if you have bloody diarrhea, high fever, or severe abdominal pain—this can make things worse 1
• Loperamide can cause serious cardiac side effects if taken in higher than recommended doses 6

Antibiotics

• Antibiotics are NOT needed for most cases of acute diarrhea and won't help viral infections 1, 2
• Using antibiotics unnecessarily can cause harm and contribute to antibiotic resistance 7

Probiotics

• Over-the-counter probiotics may help reduce the duration and severity of symptoms slightly 1

Warning Signs: When to Seek Medical Attention

Contact your healthcare provider or go to the emergency department if you develop any of these:

• Blood in your stool (red or black, tarry stools) 5, 3
• High fever (temperature >101.3°F or 38.5°C) 3, 4
• Signs of severe dehydration:
  • Decreased or no urination for 8+ hours 5
  • Extreme thirst, dry mouth, or dizziness when standing 1, 3
  • Confusion or altered mental status 1
  • Rapid heartbeat or feeling faint 3
• Severe abdominal pain or abdominal distention 6, 3
• Persistent vomiting that prevents you from keeping down any fluids 5, 3
• Diarrhea lasting more than 5 days without improvement 1, 2
• Recent hospitalization or antibiotic use in the past 3 months 3
• Weakened immune system (cancer treatment, HIV, transplant, chronic steroids) 1, 3

Prevention for Household Members

• Hand hygiene is critical: Wash hands thoroughly with soap and water after using the toilet, before eating, and before preparing food 1, 3
• Household contacts do not need preventive antibiotics 1
• Clean contaminated surfaces with bleach-based cleaners 1

Common Pitfalls to Avoid

• Don't let yourself drink large volumes rapidly if vomiting—this often worsens nausea. Instead, take small, frequent sips (1-2 teaspoons every few minutes) 5
• Don't assume you need antibiotics—most cases are viral and antibiotics won't help 1, 7
• Don't use antimotility drugs if you have bloody diarrhea or fever—this can trap bacteria in your intestines and worsen infection 1
• Don't wait to start hydration—begin replacing fluids as soon as diarrhea starts 1