The Infectious Diseases Society of America (IDSA) has issued new guidelines for the diagnosis and management of infectious diarrhea. The recommendations have been published in the journal Clinical Infectious Diseases.

The expert panel states that for the majority of patients with diarrhea, diagnostic testing is unnecessary. Testing should be reserved for children aged <5 years old, the elderly, immunocompromised patients, and those who have bloody diarrhea, severe abdominal pain/tenderness or signs of sepsis.

“However, even if they don’t need to be tested, most people will benefit from rehydration therapy while waiting for the infection to run its course.” added Andi L. Shane, MD, MPH, MSc, lead author of the guidelines, Emory University School of Medicine and Children’s Healthcare of Atlanta. 

The guidelines contain 7 reference tables with information on the various ways patients can acquire the microbes, exposure conditions, post-infectious symptoms, and clinical presentation along with management recommendations using antimicrobial drugs, fluids, and nutrition. Also, the tables aid clinicians in determining when a patient with diarrhea should be tested and treated. 

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Children with mild to moderate dehydration, patients with acute diarrhea, and those with mild to moderate dehydration associated with vomiting or severe diarrhea should be given oral rehydration solution if tolerated; if not tolerated, patients should be transitioned to intravenous rehydration. 

Compared to the 2001 guidelines, the update includes more detailed guidance and references on travel-associated diarrhea and Clostridium difficile diarrhea, among others. The full guideline can be accessed on the IDSA website.

“We need the frontline clinicians to be astute and notice if they are seeing patients with an unusual infection, or a number of similar infections from a specific location such as a child care center, nursing home or eating facility and then work closely with the state and local health authorities,” stated Larry Pickering, MD, a coauthor of the guidelines.

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