Approach to and management of acute diarrhea in adults in the emergency department setting

Acute diarrhea is a relevant public health problem and a leading cause of outpatient visits and emergency department (ED) admissions worldwide. This narrative review is intended to provide a guideline-based approach to support the management of acute diarrhea in the ED, a unique setting where physicians must manage a high volume of patients. Due to the limited availability of rapid diagnostic tests, most decisions are made empirically at the time of presentation based on clinical judgment. Hence, it is important to provide clinicians clear and practical decision-making rules to help distinguish among patients who can be safely discharged, those requiring etiological diagnosis or empiric antibiotic therapy, and those who need hospitalization. In most cases, acute diarrhea has a viral etiology, and the habitual use of antibiotics should be discouraged. However, antibiotic therapy may be appropriate for patients with severe disease, symptoms and signs suggestive of invasive bacterial infection, or those at high risk for complications. Azithromycin or a fluoroquinolone are the antibiotics of choice, depending on local susceptibility patterns and the patient’s travel history.

Acute diarrhea; Emergency department; Antibiotic therapy

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