![]() ![]() Noninfectious: negative PCR or NAAT result positive for fecal calprotectin *īacterial: enterotoxigenic Escherichia coli, Clostridium perfrin-gens, Bacillus cereus, Staphylococcus aureus, Vibrio choleraeīacterial: Salmonella, Shigella, Campylobacter, Shiga toxin–producing E. Noninfectious: negative PCR or NAAT result, positive specific laboratory testing (e.g., antitissue transglutaminase antibody) Infectious: often not performed positive PCR or NAAT result Noninfectious: abdominal pain, tenesmus, fatigue, weight loss Infectious: fever, abdominal pain, tenesmus, systemic signs and symptoms Noninfectious: nausea, abdominal discomfort, frequently without vomiting Infectious: nausea, vomiting, abdominal discomfort Noninfectious: Crohn disease, ulcerative colitis, radiation enteritis Infectious: frequently invasive or toxin-producing bacteria Noninfectious: dietary, psychosocial stressors Infectious: often viral, but may be bacterial and, less likely, parasitic 2, 5, 27, 28Ĭonsistent recommendation from evidence-based practice guidelines with high-level evidence ![]() 5, 26Ĭonsistent findings from systematic review and meta-analysisĮmpiric antibiotics can lessen the duration and severity of symptoms in moderate to severe cases of travelers’ diarrhea. When using antibiotics for travelers’ diarrhea, adjunct loperamide shortens the duration of symptoms and increases the likelihood of a cure. Single, high-quality randomized controlled trial In combination, loperamide (Imodium) and simethicone may provide faster and more complete relief of acute watery diarrhea and abdominal discomfort than either medication alone. 2, 5, 22Ĭonsistent findings from systematic review Rehydration is the first-line treatment for acute diarrhea, with oral rehydration being the preferred method for fluid replacement. 2, 5Ĭonsistent recommendation from practice guidelines with low-level evidence Stool culture or multiplex polymerase chain reaction testing should be reserved for patients with evidence of invasive disease, immunocompromise, prolonged illness, or increased risk of involvement in an outbreak. Hand hygiene, personal protective equipment, and food and water safety measures are integral to preventing infectious diarrheal illnesses. Targeted antibiotic therapy may be appropriate following microbiologic stool assessment. Empiric antibiotics are rarely warranted, except in sepsis and some cases of travelers’ or inflammatory diarrhea. Antidiarrheal agents can be symptomatic therapy for acute watery diarrhea and can help decrease inappropriate antibiotic use. Oral rehydration is preferred however, signs of severe dehydration or sepsis warrant intravenous rehydration. In all cases, management begins with replacing water, electrolytes, and nutrients. Unless an outbreak is suspected, molecular studies are preferred over traditional stool cultures. Additional diagnostic evaluation and management may be warranted when diarrhea is bloody or mucoid or when risk factors are present, including immunocompromise or recent hospitalization. ![]() Most episodes of acute diarrhea in countries with adequate food and water sanitation are uncomplicated and self-limited, requiring only an initial evaluation and supportive treatment. The physical examination should include evaluation for signs of dehydration, sepsis, or potential surgical processes. History for patients with acute diarrhea should include onset and frequency of symptoms, stool character, a focused review of systems including fever and other symptoms, and evaluation of exposures and risk factors. Infectious noninflammatory diarrhea is often viral in etiology and is the most common presentation however, bacterial causes are also common and may be related to travel or foodborne illness. Diarrhea can be categorized as inflammatory or noninflammatory, and both types have infectious and noninfectious causes. Acute diarrheal disease accounts for 179 million outpatient visits annually in the United States. ![]()
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