Acute Diarrheal Infections in Adults

Acute diarrheal infections in adults Acree M, Davis AM. JAMA. 2017;318(10):957-958. doi:10.1001/jama.2017.8485.

Key Points:                              

• Without travel, the cause of acute diarrhea is rarely known.
• Norovirus is the most common cause.
• Bacterial infections possibly amenable to antibiotic therapy include:
  • Shigella, Salmonella, Campylobacter, E. coli, and Vibrio parahaemolyticus
• Infectious causes of diarrhea > 14 days include:
  • Giardia, Cryptosporidium, Entamoeba histolytica, Cyclospora, and others
• Major recommendations:
  • NO ANTIBIOTICS for routine diarrhea or mild traveler’s diarrhea, only symptomatic treatment, possibly to include loperamide.
  • Probiotics may help for post-antibiotic diarrhea.
  • Treat bad traveler’s diarrhea with AZITHROMYCIN and loperamide.
  • Bad diarrhea > 7 days: PCR testing might be helpful.
  • Diarrhea > 14 days: start with culture and/or PCR testing.

PMID: 28898366

ABEM Level Review Questions:

A 32-year-old with no travel history presents with moderate diarrhea for 2 days and has no prior medical problems. What would be an appropriate therapy?

a. Azithromycin

b. Ciprofloxacin

c. Supportive symptomatic care and loperamide

d. Vancomycin

A 56-year-old, previously well patient with no past medical history returns from Central America and complains of 3 days of fever and bloody stools. What therapy would be appropriate?

a. Azithromycin

b. Azithromycin and loperamide

c. Ciprofloxacin

d. Vancomycin