Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults(beta)
Official guideline from the American College of Gastroenterology.
summary by Shawn Shah, MD Carl Crawford, MD
Stool should be tested (using stool culture and culture-independent methods if available) if high risk of spread and during known or suspected outbreaks.
May use stool diagnostic studies as available if dysentery, moderate-severe disease, and symptoms >7 days to diagnose and guide therapy.
Traditional stool testing has limitations → FDA-approved culture-independent methods can be recommended at least as adjunct to traditional methods.
Probiotics and prebiotics not recommended except if in post-antibiotic associated diarrhea.
Bismuth subsalicylate can be used to decrease frequency of BMs in travelers with mild-moderate symptoms.
Loperamide should be used with antibiotics for traveler's diarrhea to decrease duration and increase chance for cure.
Evidence does not support empiric antimicrobials for routine acute infection, except in TD if risk of bacterial infection outweights side effects of antibiotics.
Patient level counseling on prevention not routinely recommended, but may consider if patient or close contacts are at high risk for complications.
Pre-travel, counsel patients on high-risk foods/beverages to avoid to prevent traveler's diarrhea.
Bismuth subsalicylate is moderately effective for TD prophylaxis; may be considered if no contraindications and can adhere to frequent dosing.
Probiotics, prebiotics, and synbiotics not recommended for TD prevention.
How strong is the ACG's recommendation?