An estimated 10 to 15% of patients experience an episode of diarrhea during or after a course of antibiotic treatment. Most cases of antibiotic-associated diarrhea are benign and self-limited. These require only supportive measures or, if symptoms are severe, the discontinuation of antibiotic treatment. The most serious cause of antibiotic-associated diarrhea is Clostridium difficile colitis. C. difficile is an anaerobic gram-positive, spore-forming bacillus not normally part of the gastrointestinal flora in adults. Its spores are found in soil and as an environmental contaminant. C. difficile colitis is now the most commonly diagnosed cause of infectious diarrhea in hospitalized patients in the developed world. It has been estimated to account for up to 15% of cases of antibiotic-associated diarrhea and to incur annual treatment costs in excess of $1.1 billion in the United States. Antibiotic administration is thought to disturb the normal colon microflora and increase susceptibility to colonization by pathogenic bacteria. Although most antibiotics have been reported to cause C. difficile Read more [...]

Prevention Acute viral diarrheal illness often occurs in day care centers and nursing homes. As person-to-person contact is the mechanism by which viral disease spreads, isolation techniques must be initiated. For bacterial, parasite, and protozoal infections, strict food handling, sanitation, water, and other environmental hygiene practices can prevent transmission. If diarrhea is secondary to another illness, controlling the primary condition is necessary. Antibiotics and bismuth subsalicylate are advocated to prevent traveler's diarrhea, in conjunction with treatment of drinking water and caution with consumption of fresh vegetables. Desired Outcome If prevention is not successful and diarrhea occurs, therapeutic goals are to (a) manage thediet; (b)preventexcessive water, electrolyte, and acid-base disturbances; (c) provide symptomatic relief; (d) treat curable causes; and (e) manage secondary disorders causing diarrhea (Figs. 1 and 2). Clinicians must clearly understand that diarrhea, like a cough, may be a body defense mechanism for ridding itself of harmful substances or pathogens. The Read more [...]

Diarrhea is a troublesome discomfort that affects most individuals in the United States at some point in their lives. Usually diarrheal episodes begin abruptly and subside within 1 or 2 days without treatment. This chapter focuses primarily on noninfectious diarrhea, with only minor reference to infectious diarrhea. Diarrhea is often a symptom of a systemic disease and not all possible causes of diarrhea are discussed in this chapter. To understand diarrhea, one must have a reasonable definition of the condition; unfortunately, the literature is extremely variable on this. Simply put, diarrhea is an increased frequency and decreased consistency of fecal discharge as compared to an individual's normal bowel pattern. Frequency and consistency are variable within and between individuals. For example, some individuals defecate as often as three times per day, whereas others defecate only two or three times per week. A Western diet usually produces a daily stool weighing between 100 and 300 g, depending on the amount of nonabsorbable materials (mainly carbohydrates) consumed. Patients with serious Read more [...]

Of special concern are infants and children and elderly or debilitated patients with diarrhea. These patient populations are at increased risk from complications from diarrhea, including dehydration and electrolyte imbalances. In addition, diarrhea may be a symptom of underlying disease in certain individuals. If diarrhea is secondary to another condition, treatment of the primary disorder is most important. Parents of infants and young children should be educated about the signs of dehydration (thirst, dry mouth, concentrated urine, etc.) and should seek medical treatment if their child becomes dehydrated. The American Academy of Pediatrics recommends that, as a general rule, pharmacologic agents not be used to treat acute diarrhea in children. Patients with chronic diarrhea should be managed by identifying and treating the cause or supportively managing each diarrheal episode. Psyllium or another hydrophilic agent may improve stool consistency by absorbing excess water. Diphenoxylate and loperamide may be helpful in patients with mild to moderate secretory diarrhea. Other drugs, such as Read more [...]

Nonpharmacologic Adult individuals with acute diarrhea who are otherwise healthy are not likely to develop dehydration. Lost fluids and electrolytes can be replaced with virtually any beverage plus a source of sodium chloride (salted crackers, etc.). Patients can rest the bowel by avoiding high-fiber foods, fats, milk and other dairy products, caffeine and alcohol. A bland diet emphasizing such foods as bananas, clear soups, juice, gelatin and boiled vegetables may be helpful. The diet can gradually be returned to normal as tolerated and as stools become formed. For less than severe diarrhea, an oral glucose-electrolyte solution may be given if nausea and vomiting are not severe. Intravenous fluid therapy is necessary for the treatment of severe dehydration or diarrhea that is accompanied by severe vomiting. The degree of dehydration present determines the treatment of a child with diarrhea. Children with diarrhea who are not dehydrated should continue to be fed age-appropriate diets. Oral rehydration therapy (ORT) is the preferred treatment of fluid and electrolyte losses caused by diarrhea Read more [...]

Diarrhea is a common symptom that can range in severity from an acute, self-limited annoyance to a severe, life-threatening illness. The frequency and consistency of bowel move-ments vary within and between individuals. Some individuals may normally defecate as many as three times a day, while others only two to three times per week. Diarrhea is defined as increased volume, fluidity, or frequency of fecal discharges compared with the patient’s normal stools. Clinical features vary greatly depending on the cause, duration, and severity of the diarrhea, on the area of bowel affected, and on the patient’s general health. Etiology and Pathophysiology While there are many causes of diarrhea (see Tables 1 and 2), it is most often due to an enteritis (inflammation of the small intestine) of infectious or noninfectious etiology. In the U.S., most cases of infectious diarrhea are of viral and bacterial origin. Most infectious diarrheas are acquired by fecal-oral transmission via contaminated food or water. Improperly cooked meats may also be the source of infection. Diarrhea results from an imbalance Read more [...]

The term "diarrhea" originates from the Greek diarr, which means through, and rhein, which denotes flow. Although this descriptive term is appropriate for the symptoms, the word diarrhea may not have the same meaning for all patients and physicians. Diarrhea may denote an increase in the frequency, fluidity or volume of bowel contents, but there is no consensus on the interpretation of the term. To some, an increase in frequency without fluidity or increase in volume represents diarrhea, while for others a single component (e.g., increased frequency, or increased fluidity or volume without the other two components) does not represent this condition. To facilitate communication between physicians and patients, it is important that the history be elucidated in detail through a description of the frequency, volume and consistency of the bowel movements. The causation also is important. Diarrhea may be caused by many different diseases, and, if possible, the cause of the diarrhea should always be determined in order that appropriate treatment may be given. Another undefined question concerns the definition Read more [...]