Guidelines for adults on self-medication for the treatment of acute diarrhoea

Acute uncomplicated diarrhoea is commonly treated by self-medication. Guide lines for treatment exist, but are inconsistent, sometimes contradictory, a nd often owe more to dogma than evidence. An ad hoc multidisciplinary group has reviewed the literature to determine best practice. In general it is recognized that treatment of acute episodes relieves disco mfort and social dysfunction. There is no evidence that it prolongs the ill ness. Self-medication in otherwise healthy adults is safe. Oral loperamide is the treatment of choice. Older anti-diarrhoeal drugs are also effective in the relief of symptoms but carry the risk of unwanted ad verse effects. Oral rehydration solutions do not relieve diarrhoea, and con fer no added benefit for adults who can maintain their fluid intake. Probio tic agents are, at present, limited in efficacy and availability. Antimicro bial drugs, available without prescription in some countries, are not gener ally appropriate for self-medication, except for travellers on the basis of medical advice prior to departure. Medical intervention is recommended for the management of acute diarrhoea i n the frail, the elderly (> 75 years), persons with concurrent chronic dise ase, and children. Medical intervention is also required when there is no a batement of the symptoms after 48 h, or when there is evidence of deteriora tion such as dehydration, abdominal distension, or the onset of dysentery ( pyrexia > 38.5 degreesC and/or bloody stools).