Guide for clinical diagnosis and treatment of acute infectious diarrhea in adults

Acute infectious diarrhea is a common global health problem. Recently, the American College of Gastroenterology has updated a clinical guideline for acute infectious diarrhea in adults. The guide includes a total of 18 points, mainly describing the diagnosis, treatment and prevention of acute infectious diarrhea in adults with immune function, although not It involves refractory Clostridium-associated infections, but after each point contains recommended strength, level of evidence, and literature review for nearly 10 years.

Guide for clinical diagnosis and treatment of acute infectious diarrhea in adults

Epidemiology and public health

1. When patients have a high risk of disease transmission during a defined or suspected epidemic, if conditions permit, a diagnostic assessment should be performed using culture-independent methods. (strong recommendation, low evidence)



Diagnosis

2. When the patient has dysentery, moderate to severe diarrhea or symptoms lasting more than one week, consider a stool diagnosis study to determine the cause and target treatment. (strong recommendation, very low evidence)

3. Traditional methods such as bacterial culture, microscopy, immunofluorescence staining and antigen detection cannot find most pathogens of acute infectious diarrhea. The FDA-approved culture-free method can be used as an adjunct to traditional diagnostic methods for disease determination. (strong recommendation, low evidence)

4. Antibiotic sensitivity testing is not recommended for the treatment of patients with acute diarrhea infection. (strong recommendation, very low evidence)
Treatment

5. For elderly patients with severe diarrhea or travel patients with watery diarrhea similar to cholera, Balanced electrolyte rehydration should be used instead of other oral rehydration measures. The vast majority of patients with acute diarrhea or enteritis can maintain water-electrolyte balance by supplementing water, juice, sports drinks, soups and salty biscuits. (strong recommendation, medium evidence)

6. It is not recommended to use prebiotics or probiotics to treat acute diarrhea in adults, except for post-antibiotic-associated illness. (strong recommendation, medium evidence)

7. In the case of mild to moderate diarrhea, Bismuth subsalicylates (BBS) can effectively control the number of stools of the traveler. (strong recommendation, high evidence)

8. Loprefamine as adjunctive therapy for travel patients receiving antibiotic treatment can shorten the course of disease and increase the likelihood of cure. (strong recommendation, medium evidence)

9. Empirical antibiotics are recommended for travel patients with diarrhea, rather than conventional acute diarrhea, because the likelihood of bacterial pathogens in travel patients' diarrhea is much higher than that of antibiotics. (strong recommendation, high evidence)

10. Antibiotics should be avoided in community-acquired diarrhoea because most community-acquired diarrhea is caused by a viral infection. (strong recommendation, very low evidence)

Assessment of persistent symptoms

11. Serological and clinical laboratory tests are not recommended for patients with persistent diarrhea for 14 to 30 days. (strong recommendation, very low evidence)
12. Endoscopy is not recommended for patients with persistent diarrhea for 14 to 30 days and a negative stool test. (strong recommendation, very low evidence)

Prevent

13. Patients with high-risk complications and their close contacts may be considered for acute intestinal infection prevention counseling based on patient levels. (medium recommendation, very low evidence).

14. In order to prevent the occurrence of diarrhea during travel, it is feasible to avoid consultation on high-risk foods and beverages. (medium recommendation, very low evidence)

15. Although frequent and effective hand washing and the use of alcohol-containing hand-eliminants to prevent travel diarrhea (Traveler's diarrhea, TD) have limited effect, it can effectively prevent diarrhea caused by low-volume pathogens, such as norovirus infections on cruise ships. Epidemic diarrhea and so on. (medium recommendation, very low evidence)

16. Travellers such as the use of non-sodium salicylate is contraindicated and good compliance, can be considered to prevent diarrhea. (strong recommendation, high evidence)

17. It is not recommended to use probiotics, prebiotics, and synbiotics to prevent travel diarrhea. (recommended, medium evidence)

18. High-risk groups may consider antibiotic chemistry to prevent diarrhea, but only for short-term use. (strong recommendation, high evidence)