Review article: the history of acute infectious diarrhoea management – from poorly focused empiricism to fluid therapy and modern pharmacotherapy

Summary Background Acute diarrhoea management has progressed from largely ineffective measures in the early years to a more effective physiologic approach in recent years. Aim To review the history of acute diarrhoea management. Methods Citations in PubMed were reviewed on ‘acute diarrhoea treatment’ along with an extensive file maintained by the corresponding author. Results Freedom from diarrhoea was equated in early military conflicts with bravery and strength where diarrhoea‐free soldiers had the ‘guts’ to fight. Until early 20th century, colonic irrigants, purgatives and emetic drugs were used to help eliminate undesired intestinal contents. Only a few early authorities suggested the need for replacement of fluids and salt, now standard treatment. Drugs aimed at diarrhoea symptom control have been broadly used for more than 100 years. The evolving history of one of those drugs, kaopectate is unappreciated. Once understanding the pathophysiology and infectious aetiology of acute diarrhoea, new oral fluids, pharmacologic agents designed to block specific secretory alterations and anti‐infective drugs have been identified. Conclusions Physiologic and antimicrobial approaches to controlling diarrhoea can lead to reduction of stool number and enteric complaints, important in industrialized areas, with the potential for decreasing threat of fatal illness among infants in developing regions.