Acute infectious diarrhea
Acute diarrhea of infectious etiology in immunocompetent patients. Most cases are caused by viruses (norovirus, rotavirus) and resolve in 3–7 days with rehydration. Antibacterial therapy is justified only in severe disease, dysentery syndrome, and sepsis.
ICD-10 A094 drugs
Also known as: Acute gastroenteritis, Acute infectious diarrhea in adults
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DLactobacillus rhamnosus GG (LGG)Not recommended · Probiotic, Lacticaseibacillus rhamnosus GG strain. Supplement in Russia and Spain; in the EU and US available as food supplement or medical food; AEMPS does not register it as a medicineLGG was long promoted as standard for paediatric acute gastroenteritis – based on older Cochrane Allen 2010 RCTs, ESPGHAN 2014 endorsement and wide clinical practice. Large multicentre RCT Schnadower 2018 (PECARN, NEJM, 943 children with acute gastroenteritis) showed NO effect of LGG 1×10^10 CFU twice daily × 5 days vs placebo on diarrhoea duration, vomiting episodes or outpatient visits. Parallel Canadian Freedman 2018 RCT (NEJM, 886 children with a combined L. rhamnosus R0011 + L. helveticus R0052 probiotic, a different rhamnosus strain, not LGG) was also negative. AGA 2020 does not recommend probiotics in children or adults with acute infectious gastroenteritis. Primary therapy for acute gastroenteritis is oral rehydration (ORS); severe dehydration – intravenous infusion. If LGG was recommended as a substitute for rehydration, consider seeking a second opinion from a paediatrician.
- FChloramphenicolNot recommended · Amphenicol antibiotic for systemic useChloramphenicol tablets, sold as levomycetin in Russian-speaking pharmacies, are bought for diarrhoea, often without a prescription and on a neighbour's advice. Acute infectious diarrhoea in an adult mostly settles on its own within a few days, and the treatment is water with salts rather than an antibiotic. The FDA boxed warning is blunt: chloramphenicol must not be used for trivial infections or as prophylaxis, because fatal blood dyscrasias have followed short courses too. Chloramphenicol-induced aplastic anaemia bears no relation to dose and appears weeks or months later, when the link to the tablets is no longer obvious. In salmonella gastroenteritis an antibiotic also prolongs shedding of the organism in stool. If chloramphenicol has been suggested for diarrhoea, consider seeking a second opinion from another doctor.
- FNifuroxazideNot recommended · Intestinal antimicrobialInternational guidelines do not list nifuroxazide for adult acute infectious diarrhea. IDSA 2017, WHO 2017, and NICE CKS 2023 recommend rehydration (oral or intravenous), symptomatic loperamide in the absence of bloody stools or fever, and antibacterial therapy only in severe disease, dysentery, or sepsis – with azithromycin or ciprofloxacin. The 2019 Cochrane review found no high-quality RCTs supporting nifuroxazide efficacy. In 2019 EMA restricted the drug in children under 2 years due to an unfavorable benefit-risk balance.
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