UMEM Educational Pearls

Infectious Diarrhea:

Have your wondered what you should do with patients that you suspect have infectious diarrhea. Well the IDSA has updated their 2001 guidelines for the management of infectious diarrhea. The TAKE HOME Points are:

  • Most patients with diarrhea do not need to be tested for an infectious cause. Stop ordering those cultures.
  • Testing IS recommended in the folllowing populations:
    • Patients younger than 5 years
    • Elderly
    • Patients that are immunocompromised
    • Patients with bloody diarrhea
    • Patients with severe abdominal pain or tenderness, or have signs of sepsis.
    • Testing may be considered for C. difficile in people >2 years of age who have a history of diarrhea following antimicrobial use and in people with healthcare-associated diarrhea
  • Some additional recommendations that are noteworthy:
    • Fecal leukocyte examination and stool lactoferrin detection should NOT be used to establish the cause of acute infectious diarrhea
    • A peripheral white blood cell count and differential and serologic assays should NOT be performed to establish an etiology of diarrhea
    • Reduced osmolarity oral rehydration solution (ORS) is recommended as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause


You can find all the recommendations at




Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Oct 19. doi: 10.1093/cid/cix669