Diagnosis and Management of Infectious Diarrhea

Document Overview

Document Title

Diagnosis and Management of Infectious Diarrhea

Authoring Society

Infectious Diseases Society of America

Document Publication Date

Nov 29, 2017

Page Last Reviewed/Updated

May 5, 2026

Document Type

Guideline

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

academic.oup.com/cid/article/65/12/1963/4655039

Source Citation

Shane AL et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669.

Supplemental Implementation Resources

• Quick-Reference Guide
• Podcast
• Quick-Reference Guide

Document Scope, Criteria, and Use Cases

Scope

Assessment and Screening, Diagnosis, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D003967 - Diarrhea

D004403 - Dysentery

D003967 - Diarrhea

D004403 - Dysentery

Keywords

diarrhea, dysentery, infectious diarrhea

Target Patient Population

infants, children, adolescents, and adults in the United States with acute or persistent infectious diarrhea

Target Provider Population

healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older Adult

Health Care Settings

Ambulatory, Childcare Center, Correctional Facility, Hospital, Long Term Care

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

1. In people with diarrhea, which clinical, demographic, or epidemiologic features have diagnostic or management implications?
2. In people with fever or bloody diarrhea, which clinical, demographic, or epidemiologic features have diagnostic or management implications?
3. What clinical, demographic, or epidemiologic features are associated with complications or severe disease?
4. Which pathogens should be considered in people presenting with diarrheal illnesses, and which diagnostic tests will aid in organism identification or outbreak investigation?
5. Which diagnostic tests should be performed when enteric fever or bacteremia is suspected?
6. When should testing be performed for Clostridium difficile?
7. What is the optimal specimen (eg, stool, rectal swab, blood) for maximum yield of bacterial, viral, and protozoal organisms (for culture, immunoassay, and molecular testing)?
8. What is the clinical relevance of fecal leukocytes or lactoferrin or calprotectin in a person with acute diarrhea?
9. In which clinical scenarios should nonmicrobiologic diagnostic tests be performed (eg, imaging, chemistries, complete blood count, and serology)?
10. What follow-up evaluations of stool specimens and nonstool tests should be performed in people with laboratory-confirmed pathogen-specific diarrhea who improve or respond to treatment, and in people who fail to improve or who have persistent diarrhea?
11. When is empiric antibacterial treatment indicated for children and adults with bloody diarrhea and, if indicated, with what agent?
12. When is empiric treatment indicated for children and adults with acute, prolonged, or persistent watery diarrhea and, if indicated, with what agent?
13. How should treatment be modified when a clinically plausible organism is identified from a diagnostic test?
14. How should rehydration therapy be administered?
15. When should feeding be initiated following rehydration?
16. What options are available for symptomatic relief, and when should they be offered?
17. What is the role of a probiotic or zinc in treatment or prevention of infectious diarrhea in children and adults?
18. Which asymptomatic people with an identified bacterial organism from stool culture or molecular testing should be treated with an antimicrobial agent?
19. What strategies, including public health measures, are beneficial in preventing transmission of pathogens associated with infectious diarrhea?
20. What are the relative efficacies and effectiveness of vaccines (rotavirus, typhoid, and cholera) to reduce and prevent transmission of pathogens associated with infectious diarrhea, and when should they be used?
21. How does reporting of nationally notifiable organisms identified from stool specimens impact the control and prevention of diarrheal disease in the United States?

Number of Source Documents

223

Literature Search Start Date

Monday, January 31, 2000

Literature Search End Date

Sunday, December 1, 2013

Includes peer/external review process?

Yes

Includes public comment process?

No

Methodologist involvement?

Yes

Patient involvement?

No

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

Yes

Grades quality of strength of recommendation?

Yes

Discloses funding source?

Yes

Discloses conflicts of interest?

Yes

Includes benefits/harms analysis with recommendations?

Yes