IDSA issues updated guidelines on infectious diarrhea

Among the recommendations, physicians should obtain a detailed clinical exposure history from all people with diarrhea, and patients who have fever or bloody diarrhea should be evaluated for enteropathogens that may respond to antimicrobial agents.


The Infectious Diseases Society of America (IDSA) recently issued updated guidelines on diagnosis and management of infectious diarrhea.

The guidelines, which replace the IDSA's 2001 guidelines on this topic, were developed by a panel of multidisciplinary experts and are based on literature published from Jan. 1, 2000, through Dec. 31, 2013, with consideration of data published after Jan. 1, 2014.

Physicians should obtain a detailed clinical exposure history from all people with diarrhea, including when there is a similar history in other patients (strong recommendation, moderate-quality evidence), the guidelines said. In addition, the guidelines said, patients with diarrhea who attend or work in child care centers, long-term care facilities, patient care, food service, or venues such as pools or lakes should follow jurisdictional recommendations for outbreak reporting and infection control (strong recommendation, high-quality evidence).

Patients who have fever or bloody diarrhea should be evaluated for enteropathogens that may respond to antimicrobial agents (strong recommendation, low-quality evidence), the guidelines said. In addition, clinicians should consider enteric fever in febrile patients with or without diarrhea who have traveled where causative agents are endemic, who have eaten foods prepared by people with recent endemic exposure, or who have laboratory exposure to Salmonella enterica subspecies enterica serovar Typhi and Salmonella enterica subspecies enterica serovar Paratyphi (strong recommendation, moderate evidence). All patients with acute diarrhea should be evaluated for dehydration (strong recommendation, high-quality evidence), the guidelines said. The IDSA noted in a press release that molecular-based tests are not needed in most cases of diarrhea but should be done in children younger than age five, elderly patients, immunocompromised patients, and patients with bloody diarrhea, severe abdominal pain or tenderness, or signs of sepsis.

Other topics covered in the guidelines include diagnostics, empirical and directed management of infectious diarrhea, supportive treatment, ancillary management, and prevention. The guidelines noted that while advances have been made in molecular-based diagnostics for infectious diarrhea, optimal management primarily involves taking a thorough history of exposure and performing a physical exam. “This information enables the clinician to selectively apply diagnostics and judiciously administer therapy,” the guideline authors wrote. “Interrupting transmission of communicable enteric infections is essential in preserving public health.”

The guidelines were published online on Oct. 19 by Clinical Infectious Diseases and are available free of charge.