Riddle Infectious Diarrhea Blog Banner April 2016

Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

CAPT Mark S. Riddle, MD, DrPH, Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD; Herbert L. DuPont, MD, University of Texas Health Science Center at Houston; Bradley A. Connor, MD, Weill Medical College of Cornell University

Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. The College has published a new ACG Clinical Guideline in which the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both U.S.-based and travel settings.

Dr. Riddle comments on what’s new here:

  • The new ACG guideline applies the GRADE system of development including weighting of benefit/risk and quality of evidence
  • With the arrival of FDA approved culture-independent multi-pathogen diagnostics, use of these tests are now considered within the algorithm to help identify causes and tailor specific therapy  — particularly for symptoms lasting more than 2 weeks
  • Probiotics and prebiotics for treatment are considered (not recommended)
  • Simplified treatment for bacterial diarrheas

Dr. Riddle provides suggestions for healthy adult patients about preventing diarrheal infections, particularly travelers’ diarrhea:


  • Handwashing is a good idea (always, for many reasons).  However, it may be of limited value in the traveler setting, but may be useful in situations where low-dose pathogens are responsible for illness (e.g., institutional outbreak, cruise ship)
  • While avoiding risky food/hotel water/ice makes a lot of sense, studies do not show that this really works in travelers
  • If the trip is really critical, or the traveler has underlying health conditions (such as inflammatory bowel disease), short term chemoprohylaxis with rifaximin should be considered


  • Travelers should be given antibiotics and loperamide along with education on how to self-treat should they become ill.   Usually it only takes a single dose of antibiotics with loperamide to achieve cure in a majority of cases.