ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Overview

Journal Am J Gastroenterol

Specialty Gastroenterology

Date 2016 Apr 13

PMID 27068718

Citations 112

Authors

Mark S Riddle

Herbert L DuPont

Bradley A Connor

Affiliations

Soon will be listed here.

Abstract

Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings.

Citing Articles

Clinical and microbiological profile of patients with diarrhea evaluated using the gastrointestinal panel in a high-complexity center.

Salazar-Arenas J, Hurtado-Bermudez L, Salazar-Cardona E, Rojas-Rojas N, Cubides-Martinez J, Toro-Palma J BMC Gastroenterol. 2025; 25(1):147.

PMID: 40050761 PMC: 11887205. DOI: 10.1186/s12876-025-03693-6.

Clinical analysis of risk factors for diarrhea associated with enteral nutrition in post-craniocerebral surgery patients.

Zhang L, Zhang L, Zhu X, Xu L, Zhu L, Zhou H Front Nutr. 2025; 12:1443243.

PMID: 39980682 PMC: 11839421. DOI: 10.3389/fnut.2025.1443243.

Evaluation of the antidiarrheal activity of the 80% hydromethanolic crude extract and solvent fractions of Fresen (Combretaceae) leaves in mice.

Kassaw K, Wondafrash D, Yesuf J, Mengistie M Front Pharmacol. 2025; 15:1510171.

PMID: 39931513 PMC: 11808147. DOI: 10.3389/fphar.2024.1510171.

Prospective evaluation of different faecal preservation media for travellers' diarrhoea diagnostic application with multiplex PCR BioFire FilmArray in resource-limited settings.

Toriro R, Woolley S, Hale I, Bennett C, Phelps C, Nevin W J Med Microbiol. 2025; 74(1).

PMID: 39887178 PMC: 11784588. DOI: 10.1099/jmm.0.001954.

Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000-2023): a systematic review and meta-analysis.

Derakhshan-Sefidi M, Eidy F, Nadi-Ravandi S, Bagheri-Josheghani S, Mirfakhraei M BMC Gastroenterol. 2025; 25(1):43.

PMID: 39881226 PMC: 11776153. DOI: 10.1186/s12876-025-03634-3.

References

Beckmann C, Heininger U, Marti H, Hirsch H . Gastrointestinal pathogens detected by multiplex nucleic acid amplification testing in stools of pediatric patients and patients returning from the tropics. Infection. 2014; 42(6):961-70. DOI: 10.1007/s15010-014-0656-7. View

Pepin J, Saheb N, Coulombe M, Alary M, Corriveau M, Authier S . Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005; 41(9):1254-60. DOI: 10.1086/496986. View

Hubner N, Hubner C, Wodny M, Kampf G, Kramer A . Effectiveness of alcohol-based hand disinfectants in a public administration: impact on health and work performance related to acute respiratory symptoms and diarrhoea. BMC Infect Dis. 2010; 10:250. PMC: 2939638. DOI: 10.1186/1471-2334-10-250. View

DuPont H . Bismuth subsalicylate in the treatment and prevention of diarrheal disease. Drug Intell Clin Pharm. 1987; 21(9):687-93. DOI: 10.1177/106002808702100901. View

Jones T, Scallan E, Angulo F . FoodNet: overview of a decade of achievement. Foodborne Pathog Dis. 2007; 4(1):60-6. DOI: 10.1089/fpd.2006.63. View

Riddle M, Arnold S, Tribble D . Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler's diarrhea: a systematic review and meta-analysis. Clin Infect Dis. 2008; 47(8):1007-14. DOI: 10.1086/591703. View

Fung H, Doan T . Tinidazole: a nitroimidazole antiprotozoal agent. Clin Ther. 2006; 27(12):1859-84. DOI: 10.1016/j.clinthera.2005.12.012. View

Hill D, Ericsson C, Pearson R, Keystone J, Freedman D, Kozarsky P . The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43(12):1499-539. DOI: 10.1086/508782. View

Duggan C, Fontaine O, Pierce N, Glass R, Mahalanabis D, Alam N . Scientific rationale for a change in the composition of oral rehydration solution. JAMA. 2004; 291(21):2628-31. DOI: 10.1001/jama.291.21.2628. View

10.

Koo H, Koo D, Musher D, DuPont H . Antimotility agents for the treatment of Clostridium difficile diarrhea and colitis. Clin Infect Dis. 2009; 48(5):598-605. DOI: 10.1086/596711. View

11.

Adler A, Roll S, Marowski B, Drossel R, Rehs H, Willich S . Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum. 2007; 50(10):1628-38. DOI: 10.1007/s10350-007-9029-y. View

12.

Liu P, Yuen Y, Hsiao H, Jaykus L, Moe C . Effectiveness of liquid soap and hand sanitizer against Norwalk virus on contaminated hands. Appl Environ Microbiol. 2009; 76(2):394-9. PMC: 2805232. DOI: 10.1128/AEM.01729-09. View

13.

Wahnschaffe U, Ignatius R, Loddenkemper C, Liesenfeld O, Muehlen M, Jelinek T . Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas. Scand J Gastroenterol. 2007; 42(3):391-6. DOI: 10.1080/00365520600881193. View

14.

Vlieghe E, Jacobs J, Van Esbroeck M, Koole O, Van Gompel A . Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006. J Travel Med. 2008; 15(6):419-25. DOI: 10.1111/j.1708-8305.2008.00236.x. View

15.

Stoll R, Ruppin H, Domschke W . Calmodulin-mediated effects of loperamide on chloride transport by brush border membrane vesicles from human ileum. Gastroenterology. 1988; 95(1):69-76. DOI: 10.1016/0016-5085(88)90292-2. View

16.

Kamm K, Feikin D, Bigogo G, Aol G, Audi A, Cohen A . Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya. Trop Med Int Health. 2014; 19(4):398-406. PMC: 4681268. DOI: 10.1111/tmi.12263. View

17.

HILTON , Kolakowski , Singer , Smith . Efficacy of Lactobacillus GG as a Diarrheal Preventive in Travelers. J Travel Med. 1997; 4(1):41-43. DOI: 10.1111/j.1708-8305.1997.tb00772.x. View

18.

DuPont H . New insights and directions in travelers' diarrhea. Gastroenterol Clin North Am. 2006; 35(2):337-53, viii-ix. DOI: 10.1016/j.gtc.2006.03.008. View

19.

Raich T, Powell S . The changing landscape of diagnostic testing for diarrheal disease. MLO Med Lab Obs. 2014; 46(4):36, 38. View

20.

Ortega Y, Sanchez R . Update on Cyclospora cayetanensis, a food-borne and waterborne parasite. Clin Microbiol Rev. 2010; 23(1):218-34. PMC: 2806662. DOI: 10.1128/CMR.00026-09. View