What is the treatment for diarrhea (gastroenteritis)?

From the Guidelines

The primary treatment for diarrhea should focus on addressing dehydration, identifying the cause, and managing symptoms, with oral rehydration solutions like Pedialyte being the first-line therapy for mild to moderate dehydration, as recommended by the 2017 IDSA guidelines 1. The treatment approach for diarrhea involves several key steps:

• Assessing the severity of dehydration by checking vital signs, skin turgor, and mental status.
• Using oral rehydration solutions like Pedialyte for mild to moderate dehydration, with the recommendation of 50–100 mL/kg over 3–4 hours for infants and children, and 2–4 L for adolescents and adults 1.
• Administering intravenous fluids, typically normal saline or lactated Ringer's solution, for severe dehydration.
• Considering medications such as loperamide (Imodium) for symptom control, but avoiding its use in cases of suspected inflammatory or infectious diarrhea, as per the guidelines 1.
• Using antibiotics like azithromycin or ciprofloxacin if a bacterial infection is suspected, with azithromycin being the preferred first-line agent for dysentery and acute watery diarrhea with fever, due to its efficacy and safety profile 1.
• Gradually reintroducing bland foods, such as the BRAT diet, and avoiding dairy, caffeine, and high-fat foods until recovery. These interventions aim to replace lost fluids and electrolytes, slow intestinal motility, and address infectious causes when present, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Dehydration Fluid and electrolyte depletion often occur in patients who have diarrhea In such cases, administration of appropriate fluid and electrolytes is very important. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).

Diarrhea ER Treatment:

• The treatment of diarrhea with loperamide hydrochloride is symptomatic.
• Fluid and electrolyte therapy is important in patients with diarrhea to prevent dehydration.
• Loperamide hydrochloride should be used with caution in pediatric patients due to the greater variability of response in this age group 2.
• Specific treatment should be given when an underlying etiology can be determined.

From the Research

Diarrhea Treatment Options

• The treatment of diarrhea can vary depending on the severity and cause of the condition.
• For travelers' diarrhea, a combination of loperamide and azithromycin has been shown to be more effective than azithromycin alone in reducing the duration and severity of symptoms 3.
• In cases of mild travelers' diarrhea, the use of bismuth subsalicylate or loperamide may be considered, while for moderate cases, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used 4.
• For severe diarrhea, particularly in children, rehydration therapy is crucial, and oral rehydration solutions (ORS) can be effective in replacing lost fluids and electrolytes 5, 6.
• However, some studies suggest that traditional ORS formulations may not be optimized for treating diarrhea, and alternative formulations that reduce stool volume and duration of diarrhea may be needed 7.

Rehydration Therapy

• Rehydration therapy is a critical component of diarrhea treatment, particularly in children and individuals with severe dehydration.
• Oral rehydration therapy (ORT) is the preferred method for treating mild to moderate dehydration, while intravenous rehydration may be necessary for severe cases 5, 6.
• The use of commercially available ORS is recommended over homemade solutions, and early reintroduction of milk, formula, or solid food is important for recovery 6.

Antibiotic and Antidiarrheal Agents

• Antibiotic and antidiarrheal agents are not always necessary for treating diarrhea, and their use should be judicious and based on the specific cause and severity of the condition 4, 6.
• Loperamide may be used as monotherapy or adjunctive therapy for travelers' diarrhea, while antibiotics such as azithromycin and fluoroquinolones may be used for moderate to severe cases 3, 4.