Acute diarrheal infections in adults Acree M, Davis AM. JAMA. 2017;318(10):957-958. doi:10.1001/jama.2017.8485.
- 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.
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?
c. Supportive symptomatic care and loperamide
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?
b. Azithromycin and loperamide