Clinical question: What is the best management of acute or persistent infectious diarrhea in adults and children?
Background: The last set of guidelines from the Infectious Diseases Society of America (IDSA) regarding acute or persistent infectious diarrhea in adults and children was published in 2001. This provides a comprehensive evidence-based update.
Dr. Joanna M. Bonsall
Study design: Multistep, weighted systematic literature review.
Setting: Expert panel assembled by IDSA.
Synopsis: A panel of experts convened by IDSA reviewed studies through December 2013, focusing on acute or persistent infectious diarrhea in infants, children, adolescents, and adults in the United States. Using GRADE criteria, the panel generated 60 recommendations. Recommendations of interest to hospitalists include those for testing and treating acute diarrhea. Testing stool for bacterial pathogens is recommended for patients with diarrhea and fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or sepsis (additional testing is recommended in immunocompromised patients). Blood cultures are recommended for those who are less than 3 months of age, septic, or at risk for enteric fever. Antibiotics are not recommended for immunocompetent adults or children with either watery or bloody diarrhea, unless sepsis is present or the patient is less than 3 months of age with a presumed bacterial etiology in the latter. Recommendations regarding Clostridium difficile infections are not included in these guidelines.
Bottom line: These updated guidelines provide evidence-based recommendations for the management of acute or persistent diarrhea in infants, children, adolescents, and adults.
Citation: Shane AL et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017 Nov 29; 65(12):1963-73. doi: 10.1093/cid/cix959.
Dr. Bonsall is associate professor of medicine in the division of hospital medicine, Emory University, Atlanta.