Practice guidelines for the management of infectious diarrhea

The widening array of recognized enteric pathogens and the increasing deman d for cost-containment sharpen the need for careful clinical and public hea lth guidelines based on the best evidence currently available. Adequate flu id and electrolyte replacement and maintenance are key to managing diarrhea l illnesses. Thorough clinical and epidemiological evaluation must define t he severity and type of illness (e. g., febrile, hemorrhagic, nosocomial, p ersistent, 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 diag nostic 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 isolat es resistant to antimicrobial agents and the risk of worsened illness (such as hemolytic uremic syndrome with Shiga toxin-producing Escherichia coli O 157: H7) further complicate antimicrobial and antimotility drug use. Thus, prevention by avoidance of undercooked meat or seafood, avoidance of unpast eurized 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.