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IDSA Guidelines on Infectious Diarrhea

Clin Infect Dis; ePub 2017 Oct 19; Shane, et al

The majority of people with diarrhea do not need to be tested, according to new clinical practice guidelines from the Infectious Diseases Society of America (IDSA) on the diagnosis and management of infectious diarrhea. The guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea and offer recommendations on when to test, when to treat, and when to notify public health officials. Among the recommendations and highlights:

  • Most people with diarrhea do not need to be tested; however,
  • Those who should be considered for diagnostic testing include children aged <5 years, the elderly, people who are immune-compromised, and those with bloody diarrhea, severe abdominal pain or tenderness, or signs of sepsis.
  • 7 tables are included that clinicians can quickly reference for information about the various ways people acquire the microbes, exposure conditions, post-infectious symptoms, and clinical presentation, as well as recommended antimicrobial, fluid, and nutritional management.
  • The tables also help clinicians assess when a person with diarrhea should be tested and provide treatment considerations.

Citation:

Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. [Published online ahead of print October 19, 2017]. Clin Infect Dis. doi:10.1093/cid/cix669.

Commentary:

The guidelines make it clear that most people with diarrhea can be treated empirically with attention to hydration. For diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis, stool testing should be performed. Tests should be done for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and Shiga toxin producing E. coli. For immunocompromised people with diarrhea, a different approach with a broad differential is recommended, including consideration of infections with Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium complex, and cytomegalovirus (CMV). While travelers’ diarrhea does not require diagnostic testing, travelers’ diarrhea lasting 14 days or longer should be evaluated for intestinal parasitic infections. In immunocompetent children and adults, empiric antimicrobial therapy for bloody diarrhea while waiting for results of investigations is not recommended, except in the case of infants below 3 months of age or in that of an individual who is particularly ill and has fever, abdominal pain, bloody diarrhea, and frequent bloody stools, which might be due to Shigella. When empiric treatment is recommended, either a fluoroquinolone such as ciprofloxacin, or azithromycin are considered reasonable choices. For more information, the Infectious Diseases Society of America has produced a podcast of the guidelines that runs about 20 minutes which is available at: https://itunes.apple.com/us/podcast/infectious-diseases-society-of-ameri... —Neil Skolnik, MD

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