Acute Diarrhea and Vomiting Management

Rehydration Therapy

The American College of Physicians and Infectious Diseases Society of America recommend oral rehydration therapy with reduced osmolarity oral rehydration solution (ORS) as the first-line treatment for acute diarrhea and vomiting, along with early resumption of normal diet after rehydration is complete 1, 2
For children, the Centers for Disease Control and Prevention suggest administering 50-100 mL/kg of ORS over 3-4 hours, while for adults, similar principles apply with volume adjusted for weight 1, 3
The World Health Organization recommends small, frequent volumes (5-10 mL) of ORS every 1-2 minutes if vomiting is present, with gradual increase as tolerated 4, 5
Nasogastric administration of ORS may be considered for those who cannot tolerate oral intake but have normal mental status, as per the Infectious Diseases Society of America 1, 2

The American Academy of Pediatrics recommends continued breastfeeding throughout the diarrheal episode in infants and children, and resuming age-appropriate normal diet during or immediately after rehydration 1, 2
Early refeeding is recommended rather than withholding food, according to the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition 6

The Infectious Diseases Society of America suggests loperamide may be given to immunocompetent adults with acute watery diarrhea once adequately hydrated, but should NOT be given to children under 18 years with acute diarrhea 1, 7
Antimotility drugs should be avoided in cases of inflammatory diarrhea, diarrhea with fever, or when toxic megacolon is suspected, as per the American College of Gastroenterology 1

The Centers for Disease Control and Prevention recommend medical evaluation for possible antimicrobial treatment in cases of bloody diarrhea 5
Probiotics may be considered to reduce symptom severity and duration, according to the World Gastroenterology Organisation 2

The American Academy of Pediatrics recommends seeking medical attention for inability to tolerate oral fluids, worsening signs of dehydration, development of bloody diarrhea, or significant increase in fever 6