Treatment

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 pain
  • 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).

Reference:

1. Prescriber (2003), 14 (20), 48-60.
2. Ned Tijdschr Geneeskd. 2003 Apr 5;147(14):670-2.
3. Eur J Clin Pharmacol. 1991;40(4):415-6.