Infectious diarrhea

Infectious diarrhea is the fifth leading cause of death worldwide.

There are 179 million cases of acute diarrhea per year in the US.

Most diarrheal illnesses are self-limited and do not require evaluation or treatment beyond supportive care.

Some infections do require antimicrobial therapy and diagnostic testing and treatments may potentially minimize unnecessary costs, decrease adverse events, optimize clinical outcomes, and limit antibiotic resistance.

Diagnostic testing is not recommended for cases of suspected infectious diarrhea, including travelers diarrhea, diarrhea in immunocompromised patients because the likelihood of isolating bacterial pathogen’s is low and the use of antibiotics is almost always unnecessary.

Testing for specific pathogens by molecular or culture based methods is recommended for patients with fever, bloody or mucoid stools, severe abdominal pain, or sepsis.

Several clinical trials and meta-analyses have demonstrated patients with bacterial causes of diarrhea but without sepsis have only modest benefits from antibiotic treatment.

Antibiotic choice is heterogeneous and studies show increased risk of adverse events and antimicrobial resistance associated with the antibiotic treatment.

There is weak evidence to use probiotics for acute infectious diarrhea, including a meta-analysis and clinical trials showing a reduction of 25 hours in total symptom duration and a reduction in stool frequency on the second day of symptoms.

Most probiotic data is from pediatric patients and results of participants with a viral cause of infectious diarrhea are more favorable than those with bacterial causes.

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