Acute diarrhea in adults
Loose stools more than 3 times daily lasting up to 14 days. Self-limited in most adults; rehydration is the cornerstone. Antibiotics and antidiarrheals are used selectively after clinical assessment.
ICD-10 A092 drugs
Also known as: Acute infectious diarrhea
Drugs used for this condition
- BDiosmectiteCase-by-case decision · Intestinal adsorbents (natural smectite)In acute diarrhea in adults, the basis of treatment is oral rehydration; diosmectite (smectite) is an optional symptomatic adsorbent that modestly shortens the duration of diarrhea. Adult evidence is limited: a single RCT (Khediri, 2011, n=346) showed the median recovery time fall from 69 to 54 hours (about a 15-hour difference) with good tolerability, and the certainty is low (single RCT). The larger smectite data come from children (Cochrane, Perez-Gaxiola, 2018) and do not transfer directly to adults. ACG 2016 (acute diarrheal infections in adults) does not make diosmectite first-line and does not recommend against it.
- BLoperamideFirst line · AntipropulsivesIn acute diarrhea in adults, the first line is oral rehydration (ORS); loperamide is a symptomatic antidiarrheal that slows motility and reduces stool frequency. Guidelines (IDSA 2017) recommend it as an adjunct with a weak, conditional recommendation in non-invasive watery diarrhea in immunocompetent adults, and more firmly as an add-on to an antibiotic in traveler's diarrhea. Loperamide is contraindicated in invasive or inflammatory diarrhea (blood in stool, high fever, dysentery) and in C. difficile infection. Dose: 4 mg loading, then 2 mg after each loose stool, up to 16 mg/day.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit