From the Guidelines
The best treatment for diarrhea is oral rehydration solutions (ORS) as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, reduced osmolarity ORS is recommended for mild to moderate dehydration. The guidelines suggest that ORS should be given at a dose of 50-100 mL/kg over 3-4 hours for infants and children, and 2-4 L for adolescents and adults.
For severe dehydration, intravenous isotonic crystalloid boluses are recommended until pulse, perfusion, and mental status return to normal 1. Nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration who cannot tolerate oral intake 1.
In addition to ORS, maintenance fluids should be administered to replace ongoing losses in stools until diarrhea and vomiting are resolved 1. It is also important to note that antimotility agents such as loperamide should not be given to children <18 years of age with acute diarrhea, but may be given to immunocompetent adults with acute watery diarrhea 1.
Overall, the key to managing diarrhea is to stay hydrated and replace lost fluids and electrolytes. Oral rehydration solutions are the most effective way to do this, and should be used as the first-line treatment for mild to moderate dehydration. If symptoms persist or worsen, medical attention should be sought.
Some key points to consider when treating diarrhea include:
- Maintaining adequate fluid intake to prevent dehydration
- Using oral rehydration solutions to replace lost fluids and electrolytes
- Avoiding dairy, caffeine, alcohol, and fatty foods until recovered
- Considering the use of antimotility agents such as loperamide in adults, but not in children
- Seeking medical attention if symptoms are severe or persistent.
It is also important to note that the use of antimicrobial agents is not generally recommended for self-medication, except for travelers to resource-challenged countries on the basis of medical advice prior to departure 1.
In terms of specific treatments, the guidelines recommend the following:
- For mild to moderate dehydration, ORS should be given at a dose of 50-100 mL/kg over 3-4 hours for infants and children, and 2-4 L for adolescents and adults
- For severe dehydration, intravenous isotonic crystalloid boluses should be administered until pulse, perfusion, and mental status return to normal
- For maintenance fluids, ORS should be given to replace ongoing losses in stools until diarrhea and vomiting are resolved.
Overall, the best treatment for diarrhea is a combination of oral rehydration solutions, maintenance fluids, and careful monitoring of symptoms. Oral rehydration solutions are the most effective way to replace lost fluids and electrolytes, and should be used as the first-line treatment for mild to moderate dehydration.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older and of chronic diarrhea in adults associated with inflammatory bowel disease. The best treatment for diarrhea is loperamide (PO), as it is indicated for the control and symptomatic relief of acute nonspecific diarrhea and chronic diarrhea in adults associated with inflammatory bowel disease 2.
- Key points:
- Indicated for acute nonspecific diarrhea in patients 2 years of age and older
- Indicated for chronic diarrhea in adults associated with inflammatory bowel disease
- Reduces the volume of discharge from ileostomies
From the Research
Treatment Options for Diarrhea
- Oral rehydration therapy is a widely recommended treatment for diarrhea, as it is inexpensive, effective, and adaptable 3, 4.
- The standard oral replacement solution recommended by the World Health Organization is widely available and has demonstrated safety and effectiveness 3.
- Modifications to the standard oral rehydration solution, such as hypo-osmolar or hyperosmolar solutions, rice-based oral rehydration solutions, and zinc supplementation, have been derived and some have been successful 4.
- For patients with Clostridium difficile-associated diarrhea, antibiotic treatment such as vancomycin, metronidazole, and teicoplanin may be effective, with teicoplanin appearing to be the best choice for both symptomatic and bacteriologic cure 5.
- Other treatment options for Clostridioides difficile infection include fidaxomicin, bezlotoxumab, and microbial replacement therapies, which have shown promise in clinical trials 6.
Considerations for Treatment
- The choice of treatment for diarrhea depends on the severity of dehydration, with oral rehydration therapy being sufficient for patients with mild dehydration 3.
- Nutritional management, including electrolytes and glucose, is also important in the management of diarrhea 3.
- For patients with Clostridium difficile-associated diarrhea, the goal of therapy is to improve the patient's clinical condition and prevent the spread of infection to other patients 5.
- The treatment of Clostridioides difficile infection is evolving, with new therapies emerging and guidelines being updated 6.
Specific Treatments
- Oral rehydration solutions have been shown to be effective in reducing mortality associated with acute diarrheal illnesses in children 4.
- Teicoplanin has been shown to be effective in treating Clostridium difficile-associated diarrhea, with a relative risk of 1.21 [95% CI 1.00 to 1.46] compared to vancomycin 5.
- Fidaxomicin and bezlotoxumab have been added to the treatment spectrum of Clostridioides difficile infection, and microbial replacement therapies are emerging as a potential treatment option 6.