Treatment Guideline Chart
Diarrhea is a change in normal bowel movements characterized by increased frequency, water content or volume of stools.
Infectious diarrhea is diarrhea of infectious origin (bacteria, virus, protozoal, fungal) and is usually associated with symptoms of nausea and vomiting, abdominal cramps and fever.
Dysentery (invasive diarrhea) has the presence of visible blood in diarrheic stool.

Diarrhea%20in%20adults%20-%20infectious Management


  • General measures to prevent diarrheal diseases may include the following:
    • Washing of hands with soap
    • Drinking clean and safe water
    • Proper human waste and garbage disposal
    • Safe food processing and handling
    • Cholera vaccination

Traveler’s Diarrhea

  • Traveler should avoid:
    • Undercooked food except peeled fruits or vegetables
    • Non-bottled beverages and unpasteurized dairy products

Water Purification

  • Travelers who are going to be living in rustic circumstances overseas will need to make arrangements for a safe water supply

Prophylactic Antibiotics 

  • Effective but cannot be recommended unless the complications of diarrhea in a traveler or severe dehydration in a person with an underlying medical condition cause the benefits of antibiotic prophylaxis to outweigh the risks
  • Rifaximin is recommended when antibiotic prophylaxis is indicated; fluoroquinolones are not recommended for prophylaxis

Bismuth Preparations

  • May have protective efficacy over a 7-day period


  • Live microorganisms that have been demonstrated in controlled human studies to confer a health benefit on the host 
    • Prebiotics are dietary substances (mostly used as ingredients in food) that can change the composition and/ or activity of the GI microbiota and can also confer health benefits 
      • Include breast milk oligosaccharides, inulin, lactulose, galacto-oligosaccharides and oligofructose 
    • Synbiotics are products with both probiotics and prebiotics and have conferred health benefits 
  • Interaction of probiotics and normal GI microbiota with the host via metabolic and immune mechanisms result in the prevention of colonization of pathogenic and opportunistic microorganisms, including a decrease in the incidence and severity of diarrhea 
  • Several controlled clinical trials have shown that some probiotic strains are likely to be safe and effective for the treatment and prevention of acute diarrhea 
  • The following probiotics can be used for the treatment of acute diarrhea in adults: Lactobacillus paracasei B 21060, L rhamnosus GG, Saccharomyces boulardii CNCM I-745, strain of S cerevisiae  


  • Prevention depends on interruption of fecal-oral transmission as V cholerae is spread through contaminated food and water
  • Water can be treated with chlorine or iodine, by filtration, or by boiling
  • Travelers to regions with cholera should follow precautions for the prevention of traveler’s diarrhea 
  • WHO recommends that cholera control programs in endemic areas and areas with cholera outbreak should include cholera vaccination

Consultation or hospitalization is considered in the following cases:

  • Bloody stools
  • Frequent and large-volume diarrhea
  • Persistent fever and vomiting
  • Severe dehydration
  • Altered consciousness
  • Elderly patients
  • Presence of or unstable chronic medical or concurrent illness
  • Intolerant of oral rehydration 
  • Poor nutritional status 
  • Social circumstances, eg lives alone or far from a hospital 
  • Presence of electrolyte abnormalities
  • Absence of improvement within 48 hours
  • No urine output in preceding 12 hours
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