Most diarrhoeas are acute and self limiting, and may indicate food intolerance, bacterial toxin infection, or enteric infection. First line management is the prevention or treatment of fluid and electrolyte depletion.

This is particularly important for infants and the elderly, and may be achieved by either home made or commercially available rehydration solutions.

Persistence of diarrhoea for more than a few days demands investigation of the cause, and institution of appropriate specific management.

Chronic diarrhoeas are usually due to the irritable bowel syndrome, malabsorptive states, such as lactose intolerance and coeliac disease, and inflammatory conditions of the bowel such as ulcerative colitis and Crohns disease.

MANAGEMENT OF ACUTE DIARRHOEAS

In simple acute diarrhoea (gastroenteritis), adults should need no medication for the first 24 hours; however early institution of ample oral fluid and electrolyte intake may be recommended, particularly in the elderly.

Acute gastroenteritis in children is a more serious condition and oral fluid and electrolyte replacement are important.

It is most frequently due to a viral infection and as viruses have been shown to damage the microvilli and thereby reduce the amount of lactase available, milk intolerance is common.

Avoidance of milk products in the acute phase is a useful general measure In acute gastroenteritis, antidiarrhoeal drugs are of secondary value & may have the undesirable effect of delaying viral clearance.

They should not be used in young children. If diarrhoea persists for longer than 24 hours these drugs may become useful, although a diagnosis then becomes more critical.

Antimicrobial agents are generally unnecessary and are definitely undesirable in simple gastroenteritis.

When a bacterial cause is found it will usually resolve within 3 4 days without the use of an antimicrobial. The finding of pathogenic bacteria after the patient's diarrhoea has settled is also not an indication for treatment.

Exceptions to this may be Cholera and certain Shigella, Salmonella and Campylobacter infections, perhaps particularly in the carrier state.

Reference:
SAMF EDITION 7