Practice guidelines for the management of infectious diarrhea

Richard L. Guerrant, Thomas Van Gilder, Laurence Slutsker, Robert V. Tauxe, Thomas Hennessy, Patricia M. Griffin, Larry K. Pickering, Ted S. Steiner, Nathan M. Thielman, Herbert DuPont, R. Bradley Sack, Phillip Tarr, Marguerite Neill, Irving Nachamkin, L. Barth Reller, Michael T. Osterholm, Michael L. Bennish

Research output: Contribution to journalReview article

Abstract

The widening array of recognized enteric pathogens and the increasing demand for cost-containment sharpen the need for careful clinical and public health guidelines based on the best evidence currently available. Adequate fluid and electrolyte replacement and maintenance are key to managing diarrheal illnesses. Thorough clinical and epidemiological evaluation must define the severity and type of illness (e.g., febrile, hemorrhagic, nosocomial, persistent, or inflammatory), exposures (e.g., travel, ingestion of raw or undercooked meat, seafood, or milk products, contacts who are ill, day care or institutional exposure, recent antibiotic use), and whether the patient is immunocompromised, in order to direct the performance of selective diagnostic cultures, toxin testing, parasite studies, and the administration of antimicrobial therapy (the latter as for traveler's diarrhea, shigellosis, and possibly Campylobacter jejuni enteritis). Increasing numbers of isolates resistant to antimicrobial agents and the risk of worsened illness (such as hemolytic uremic syndrome with Shiga toxin-producing Escherichia coli O157:H7) further complicate antimicrobial and antimotility drug use. Thus, prevention by avoidance of undercooked meat or seafood, avoidance of unpasteurized milk or soft cheese, and selected use of available typhoid vaccines for travelers to areas where typhoid is endemic are key to the control of infectious diarrhea.

Original languageEnglish (US)
Pages (from-to)331-351
Number of pages21
JournalClinical Infectious Diseases
Volume32
Issue number3
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Guerrant, R. L., Van Gilder, T., Slutsker, L., Tauxe, R. V., Hennessy, T., Griffin, P. M., Pickering, L. K., Steiner, T. S., Thielman, N. M., DuPont, H., Bradley Sack, R., Tarr, P., Neill, M., Nachamkin, I., Reller, L. B., Osterholm, M. T., & Bennish, M. L. (2001). Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases, 32(3), 331-351. https://doi.org/10.1086/318514