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The cause of the diarrhoea should be identified and treated if possible*.
The majority of cases of acute diarrhoea are managed in the primary care. Most
of the cases managed in primary care are self-limiting and mild illnesses that
require no specific treatment.
In the context of general management options for acute infectious diarrhoea
- the mainstay of treatment is supportive
- general supportive therapy in the form of fluid and electrolyte replacement
and subsequent maintenance of hydration
- oral rehydration solution e.g. WHO ORS (sodium chloride 3.5g, sodium
citrate 2.9g, potassium chloride 1.5g and glucose in one litre (WHO formula))**.
Note that cola contains a high sucrose content and virtually no sodium
and should not be used as an ORS
- children - ORS may be used to treat mild, moderate and severe diarrhoea
- if there is any deterioration then the child will require hospitalisation
where intravenous fluids may be used
- adults - with the exception of cholera, formal ORS is not often indicated
in adults where increased fluids such as fruit juices and salty soups
will suffice (1)
- symptomatic treatment to reduce bowel frequency and symptoms such as abdominal
- antimotility agents e.g. opiates (such as morphine and codeine) and
opiate analogues (such as loperamide). There are concerns that the use
of antimotility drugs in acute diarrhoea may increase the risk of colonic
dilatation (and possible perforation) and also increased carriage of gut
enteropathogens. There is little evidence to support these concerns (1)
- although these agents should not be given children - paralytic ileus
and necrotising enterocolitis have been reported with the use of antimotility
agents in children (2,3) and also there are concerns about possible CNS
effects such as respiratory depression
- other antimotility agents include berberine and specific calmodulin
inhibitors (there has been a positive correlation demonstrated between
the antidiarrhoeal activity of loperamide and calmodulin binding activity)
- antibiotics treatment - this should generally be avoided with the exception
of specific causes of dysentery and watery diarrhoea where, if possible, treatment
should be tailored to the causative organism (1)
* if a specific cause of acute diarrhoea is known then management should be
specific to that condition
** there are a number of ORS formulations available (e.g. dioralyte, rapolyte)
which differ in composition from WHO ORS with both preparations having a lower
sodium content than WHO ORS. There is evidence however that these formulations
are as effective as WHO ORS and also have the additional advantage that they
appear to be more effective in reducing faecal losses (1).
- Prescriber (2003), 14 (20), 48-60.
Tijdschr Geneeskd. 2003 Apr 5;147(14):670-2.
J Clin Pharmacol. 1991;40(4):415-6.
Last reviewed 01/2018