Guideline for the management of acute diarrhea in adults

provide a complete document that would be applicable to the case management of diarrhea. However, some explanation and amplification is necessary to clarify the terms and phrases that have been used, as well as to explain the basis for certain decision pathways in the algorithm. Adult: The definition of ‘adult’ varies from one country to another. As applied in this guideline, the term ‘adult’ refers to someone who is of age 12 years or above. Acute diarrhea: This is defined as the passage of three or more than three loose or watery stool in 24 h, or passage of one or more bloody stool. Acute diarrhea refers to illness not lasting longer than 14 days. Other conditions that may present as acute diarrhea: ‘Acute diarrhea’ is a clinical syndrome that is commonly understood to refer to infective gastroenteritis. However, as defined, acute diarrhea may be a symptom of other intra-abdominal or systemic illnesses. These other clinical conditions may require particular investigations and management, and will need to be recognized and excluded at the outset. Careful history and physical examination is necessary to exclude these conditions from the commonly understood ‘acute diarrhea’. Special attention should be paid to exclude signs of peritonism or peritonitis, which will indicate serious illnesses that might require surgical care. Examples of these diverse clinical conditions are presented in Table 1. Specific conditions of acute diarrhea that require special consideration: Although the term ‘acute diarrhea’ commonly refers to infectious, toxin-induced and drug-induced diarrhea, there are specific acute diarrhea syndromes that may need a specifically tailored approach and management, and where the general algorithm may need to be modified. For example, during epidemic acute diarrhea such as cholera, it is important to quickly identify the organism in the first patients presenting with illness, and to initiate public health meaINTRODUCTION