From the Guidelines
The primary treatment for acute diarrhea is oral rehydration therapy (ORT) with oral rehydration solutions (ORS).
Treatment Approaches
- ORT is generally appropriate for mild diarrhea 1, and can be used in conjunction with other treatments such as antimotility agents.
- Loperamide can be started at an initial dose of 4 mg followed by 2 mg every 2–4 h or after every unformed stool 1, but should be avoided in children under 18 years of age and in cases of suspected or proven toxic megacolon or inflammatory diarrhea.
- Rapid fluid resuscitation is not necessary in patients with mild to moderate hypovolaemia 1, but may be required in cases of severe dehydration or shock.
- Intravenous fluids such as lactated Ringer’s and normal saline solution should be administered when there is severe dehydration, shock, or altered mental status 1.
Additional Treatments
- Antinausea and antiemetic agents such as ondansetron may be given to facilitate tolerance of oral rehydration 1.
- Octreotide may be used in patients not responsive to loperamide and with severe toxicity 1.
- Bile acid sequestrants such as cholestyramine may be used in cases of bile salt malabsorption 1.
- Probiotics such as Lactobacillus, Bifidobacterium, and cocci may be beneficial in preventing and treating diarrhea 1.
- Uridine triacetate may be used in the management of early-onset, severe or life-threatening toxicity including diarrhea within 96 h following the end of 5-FU or capecitabine administration 1.
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 Treatment of diarrhea with loperamide hydrochloride is only symptomatic. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy
The treatment for acute diarrhea includes:
- Loperamide hydrochloride for symptomatic relief in patients 2 years of age and older
- Fluid and electrolyte therapy to prevent dehydration and electrolyte depletion It is essential to note that loperamide hydrochloride does not address the underlying cause of diarrhea, and specific treatment should be given when the underlying etiology can be determined 2, 2.
From the Research
Treatment Overview
The treatment for acute diarrhea typically involves replacing lost fluids, electrolytes, and nutrients.
- Oral rehydration is the preferred method, with oral rehydration solutions (ORS) being used to treat dehydration and prevent further fluid loss 3, 4, 5.
- In cases of severe dehydration or sepsis, intravenous rehydration may be necessary 3.
- Antidiarrheal agents can be used as symptomatic therapy for acute watery diarrhea, but empiric antibiotics are rarely warranted except in cases of sepsis or inflammatory diarrhea 3, 6.
Diagnostic Evaluation
Diagnostic evaluation may be necessary in certain cases, such as:
- Bloody or mucoid diarrhea
- Presence of risk factors, including immunocompromise or recent hospitalization
- Suspected outbreak of infectious diarrhea
- Molecular studies are preferred over traditional stool cultures for diagnostic evaluation 3.
Patient Management
Patient management involves:
- Replacing lost fluids, electrolytes, and nutrients
- Providing supportive care, such as rest and hydration
- Monitoring for signs of dehydration, sepsis, or other complications
- Providing patient counseling and education on proper hygiene and prevention measures 3, 7.
Prevention
Prevention measures include: