10 - An overview of management of infectious diarrhoea

Summary

Most enteric infections cause mild diarrhoea and no therapy is necessary in healthy individuals. Diarrhoea should be regarded with caution in the elderly who are more susceptible to the complications of even a single episode of acute diarrhoea. The elderly with an illness coexistent at the time of diarrhoea are at even greater risk.

In the management of diarrhoea a sensible balance has to be struck between unnecessary treatment and neglect on the part of both the physician and patient. With regard to the healthy elderly, medical advice should be sought if a circumstance listed below occurs:

• bloody diarrhoea

• abdominal pain and tenderness, rectal pain, tenesmus

• persistent vomiting and inability to retain fluids for a six-hour period

• fever

• evidence of dehydration

• more than five to six bowel actions in 24 hours

• patients with current medical problems

• patients on drug therapy.

The frail, debilitated elderly and patients on medication should be advised to contact their physician at the onset of diarrhoea.

The patient (and/or care-giver) should be instructed about the need for increased fluid intake and a plan agreed on further intervention. The extent of involvement of the physician and treatment would depend on the nature and course of the diarrhoeal illness and the state of the patient's existing clinical status. Guidelines for advice during an episode of diarrhoea at home are:

• decrease physical activity

• […]