Guideline Recommendations for Acute Watery Diarrhea in Adults

1. Immediate Rehydration – Cornerstone of Therapy

Reduced‑osmolarity oral rehydration solution (≈65–70 mEq/L sodium, 75–90 mmol/L glucose) is the first‑line treatment for all adults with acute watery diarrhea, irrespective of severity. Strong recommendation, high‑quality evidence from the Infectious Diseases Society of America (IDSA). [1][2]
Begin oral rehydration immediately and avoid empiric antibiotics in otherwise healthy adults; rehydration prevents morbidity and mortality. Strong recommendation, IDSA. [1][2]

2. Oral Fluid Prescription & Dehydration‑Specific Dosing

Prescribe a total fluid intake of 2.2–4.0 L per day, matching ongoing losses (urine, insensible, stool). (Guideline‑based calculation; IDSA). [2][3]
Mild dehydration (≈3–5 % fluid deficit): give 50 mL/kg of ORS over 2–4 hours. Moderate evidence, MMWR. 4
Moderate dehydration (≈6–9 % deficit): give 100 mL/kg of ORS over 2–4 hours. Moderate evidence, MMWR. 4
Continue oral rehydration until clinical signs of dehydration resolve and diarrhea has stopped. Strong recommendation, IDSA. [2][3]

3. Intravenous Fluid Replacement – When Oral Therapy Fails

Switch to isotonic IV fluids (lactated Ringer’s or normal saline) immediately for severe dehydration (≥10 % deficit) with altered mental status, inability to tolerate oral intake, or shock. Strong recommendation, IDSA. [1][2]
IV fluids are also indicated when prolonged skin tenting (>2 s), cool/poorly perfused extremities, or decreased capillary refill are present. Moderate evidence, MMWR. 4
Maintain IV rehydration until pulse, perfusion, and mental status normalize, then transition to oral rehydration for remaining deficit replacement. Strong recommendation, IDSA. [2][3]

4. Symptomatic Antimotility Therapy

Loperamide may be used after adequate rehydration in immunocompetent adults with watery diarrhea. Strong recommendation, moderate evidence, IDSA. 3
Loperamide is contraindicated in children < 18 years and in any patient with fever or bloody stools (risk of toxic megacolon). Strong recommendation, moderate evidence, IDSA. 3

5. Dietary Management

Resume a normal, age‑appropriate diet as soon as rehydration is complete. Strong recommendation, IDSA. [2][3]

6. Antibiotic Stewardship

Do not prescribe empiric antibiotics for uncomplicated acute watery diarrhea in stable, immunocompetent adults without recent international travel. Strong recommendation, IDSA. [1][2]3
Antibiotics are reserved for:
When antibiotics are indicated, azithromycin (500 mg single dose for watery diarrhea, 1000 mg for dysentery) is preferred; fluoroquinolones (e.g., ciprofloxacin 750 mg or levofloxacin 500 mg single dose) are alternatives based on local resistance patterns. 1

7. Adjunctive Therapies

Antiemetic agents such as ondansetron may be considered after adequate rehydration, but they do not replace fluid therapy. Moderate evidence, IDSA. 3

8. Assessment of Dehydration Severity (Guides Fluid Management)

Severity	Approximate Fluid Deficit	Clinical Indicators
Mild (3–5 %)	Slight thirst, mildly dry mucous membranes	[4]
Moderate (6–9 %)	Loss of skin turgor, skin tenting on pinch, dry mucous membranes	[4]
Severe (≥10 %)	Altered consciousness, prolonged skin tenting (>2 s), cool extremities, decreased capillary refill, rapid deep breathing (acidosis)	[4]

Rapid deep breathing, prolonged skin retraction, and poor perfusion are more reliable predictors of significant dehydration than the presence of a sunken fontanelle or absence of tears. Moderate evidence, MMWR. 4

9. Key Pitfalls to Avoid

Never prioritize antimotility agents over rehydration; dehydration, not diarrhea, drives morbidity and mortality. [1][2]3
Never use loperamide when fever or bloody stools are present. [1][2]3
Avoid routine antibiotic use; they do not shorten illness duration in uncomplicated watery diarrhea and promote antimicrobial resistance. Strong recommendation, IDSA. [1][2]3

Management of Watery Diarrhea in Adults

Immediate Rehydration Strategy

The Infectious Diseases Society of America (IDSA) strongly recommends starting reduced osmolarity oral rehydration solution (ORS) containing 65-70 mEq/L sodium and 75-90 mmol/L glucose immediately for all adults with acute diarrhea, with moderate evidence 5, 6, 7
For mild illness, diluted fruit juices, flavored soft drinks with saltine crackers, and broths can meet fluid and salt needs, though commercial ORS is superior for more significant symptoms 8, 9
Prescribe 2200-4000 mL/day total fluid intake, with the rate of administration exceeding ongoing losses (urine output + 30-50 mL/h insensible losses + stool losses) 8, 9
Continue ORS until clinical dehydration is corrected and diarrhea resolves 5, 6, 7

Symptomatic Management with Loperamide

Once the patient is adequately hydrated, loperamide is appropriate for immunocompetent adults with watery diarrhea, with a strong recommendation and moderate evidence from the IDSA 5, 6, 7
Start with 4 mg initially, followed by 2 mg every 2-4 hours or after each unformed stool, with a maximum of 16 mg daily 5, 8
Avoid loperamide if fever or bloody stools are present, as this suggests inflammatory diarrhea where antimotility agents risk toxic megacolon 5, 6, 7

Dietary Recommendations

Resume normal diet immediately or as soon as rehydration is complete, with a strong recommendation and low-quality evidence from the IDSA 5, 6, 7
Continue age-appropriate usual diet guided by appetite 5, 6, 7
Small, light meals are preferable initially, avoiding fatty, heavy, spicy foods and caffeine 8, 9

When to Avoid Antibiotics

Do not prescribe empiric antibiotics for uncomplicated watery diarrhea in a stable outpatient, with a strong recommendation from the IDSA 5, 6, 7
The IDSA strongly recommends against empiric antimicrobial therapy for acute watery diarrhea without recent international travel in immunocompetent patients 5, 6
Antibiotics are only indicated if: fever with bloody diarrhea, recent international travel, suspected specific pathogens (Shigella, Campylobacter, parasites), or immunocompromised status 5

Adjunctive Therapies to Consider

Probiotics may be offered to reduce symptom severity and duration, with a weak recommendation and moderate evidence from the IDSA 5, 6, 7
Selection of specific probiotic strains, dosing, and delivery route should follow manufacturer guidance and literature searches 5, 6, 7

Red Flags Requiring Escalation

If signs of severe dehydration develop (altered mental status, inability to tolerate oral intake, persistent tachycardia/hypotension), switch to intravenous isotonic fluids (lactated Ringer's or normal saline) 5, 6, 7
Severe dehydration requires IV rehydration until pulse, perfusion, and mental status normalize 5, 6, 7

Critical Pitfalls to Avoid

Never neglect rehydration while focusing on antimotility agents—dehydration causes the morbidity and mortality in diarrheal illness, not the diarrhea itself 5, 8, 9
Never use loperamide in children under 18 years, with a strong recommendation and moderate evidence from the IDSA 5, 6, 7
Avoid overhydration in elderly patients with heart or kidney failure—frequent reassessment is essential 8, 9

Management Priorities in Patients with Diarrhea

Rehydration and Electrolyte Replacement

Prompt fluid and electrolyte replacement is more critical than acid‑suppressive therapy for patients presenting with diarrhea, emphasizing rehydration as the first therapeutic step. 10
Initiate oral rehydration solution containing approximately 65–70 mEq/L sodium and 75–90 mmol/L glucose immediately in patients with mild‑to‑moderate dehydration. 10

Intravenous Fluid Therapy for Severe Dehydration

In cases of severe dehydration, administer isotonic intravenous fluids (e.g., lactated Ringer’s solution or normal saline) as the top priority, superseding any antacid use. 11

Evaluation of Persistent Diarrhea

When diarrhea continues despite appropriate antacid selection, clinicians should investigate underlying etiologies such as infectious agents, inflammatory bowel disease, or medication‑induced diarrhea. 12

Limitations of Antacid‑Only Management

Antacids alone should not be relied upon to control diarrhea; rehydration and identification of the underlying cause must be addressed first. 11

Management of Uncomplicated Acute Watery Diarrhea in Healthy Adults

Recommendations Against Empiric Antibiotics

The Infectious Diseases Society of America (IDSA) issues a strong recommendation not to use empiric antimicrobial therapy for acute watery diarrhea in immunocompetent adults without recent international travel. 13

Clinical Features That Exclude the Need for Antibiotics

Absence of fever indicates a low probability of invasive bacterial pathogens such as Shigella, Campylobacter, or Salmonella. 14
Lack of blood or leukocytes in the stool excludes dysentery and inflammatory diarrhea, conditions in which antibiotics have demonstrated benefit. [14][13]
No recent high‑risk travel rules out travelers’ diarrhea, a scenario where empiric antibiotics have been shown to shorten symptom duration from 50–93 hours to 16–30 hours. 14

Situations Where Antibiotics Are Indicated

Fever with bloody diarrhea (suggesting invasive pathogens such as Shigella, invasive E. coli, or Campylobacter) warrants antibiotic therapy. 14
Recent international travel with severe, incapacitating symptoms (travelers’ diarrhea) also justifies empiric antibiotics. [14][13]

Preferred Antibiotic Regimen

Azithromycin is recommended as the first‑line agent for watery diarrhea (single 500 mg dose) and for dysentery (single 1 g dose), reflecting rising fluoroquinolone resistance in Campylobacter. [14][13]

Adjunctive Antimotility Therapy

Loperamide may be added after adequate rehydration to lessen stool frequency and improve quality of life. 13
Recommended dosing: 4 mg initially, then 2 mg after each loose stool, not exceeding 16 mg in 24 hours. 14
Loperamide is contraindicated if fever or bloody stools develop because of the risk of toxic megacolon in invasive diarrhea. 14

Guidance on Avoiding Unnecessary Antibiotics

Empiric antibiotics should never be prescribed for uncomplicated watery diarrhea, as this promotes antimicrobial resistance without clinical benefit. 13
Antimotility agents (e.g., loperamide) should never be used when fever or bloody stools are present. 14

Indications for Stool Microbiologic Testing

Obtain stool cultures or other microbiologic studies only if any of the following occur: symptoms persist beyond 14 days, fever develops, bloody stools appear, or empiric therapy fails. 13

Dietary Recommendations for Acute Watery Diarrhea

Meal Composition

Management of Acute Watery Diarrhea in Breastfeeding Mothers

Guideline Position on Racecadotril

The Infectious Diseases Society of America (IDSA) notes that racecadotril reduces stool volume but is not available in North America and therefore is not part of standard guideline‑recommended therapy for acute diarrhea. Strong recommendation against use due to lack of availability. 16
No major guideline (IDSA, CDC, or other societies) lists racecadotril as a recommended treatment option for acute diarrhea in adults, including breastfeeding women. No recommendation (absence from guidelines). 17, 16, 18

First‑Line Fluid Management

Oral rehydration solution (ORS) containing 65–70 mEq/L sodium and 75–90 mmol/L glucose is the cornerstone of therapy and should be started immediately in any breastfeeding mother with acute watery diarrhea. Strong recommendation (IDSA). 16
ORS should be continued until clinical dehydration resolves and diarrhea stops. Strong recommendation. 16
Breastfeeding on demand should be maintained throughout the diarrheal episode, as breast milk supplies optimal nutrition and hydration for the infant. Strong recommendation (MMWR). 17

Symptomatic Pharmacologic Management (after adequate rehydration)

Loperamide may be used in immunocompetent adults once rehydration is achieved (initial 4 mg, then 2 mg after each loose stool, max 16 mg/24 h). Conditional recommendation (IDSA). 16
Loperamide is contraindicated if fever or bloody stools develop because of the risk of toxic megacolon. Strong recommendation. 16
Loperamide has established safety in lactation, with minimal transfer into breast milk, making it a safer symptomatic option than racecadotril. Strong recommendation. 16

Antibiotic Stewardship

Empiric antibiotics should not be prescribed for uncomplicated watery diarrhea lacking fever, blood in stool, or recent international travel. Strong recommendation. 16
Antibiotics are indicated only when fever with bloody diarrhea, recent travel with severe symptoms, or immunocompromised status are present. Conditional recommendation. 16

Critical Practice Pitfalls (Safety Emphasis)

Do not prioritize racecadotril or any antisecretory agent over oral rehydration; dehydration, not stool output, drives morbidity and mortality. Strong recommendation. 16
Do not use medications with unknown lactation safety when evidence‑based alternatives exist (ORS, loperamide, appropriate antibiotics). Strong recommendation. 17, 16
Do not discontinue breastfeeding because the mother has diarrhea; continued nursing benefits the infant and helps the mother maintain fluid intake. Strong recommendation. 17
Do not delay rehydration while seeking symptomatic relief; ORS must be initiated immediately. Strong recommendation. 16

Bottom‑Line Clinical Guidance

For a breastfeeding mother with acute watery diarrhea, prescribe immediate oral rehydration (2,200–4,000 mL/day total fluid), continue breastfeeding on demand, and add loperamide only after adequate rehydration if symptomatic relief is needed. Racecadotril has no established role due to absent lactation safety data and lack of guideline support. Strong recommendation. 17, 16

Safety Considerations for Antidiarrheal Agents in Pregnancy

Avoidance of Bismuth Subsalicylate

Clinical guidelines advise that bismuth subsalicylate should be avoided during pregnancy because of theoretical risks of fetal salicylate exposure. 19

Use of Stimulant Laxatives

Current evidence indicates that the safety of stimulant laxatives in pregnant patients is uncertain, and their use should be approached with caution. 20

Management of Acute Watery Diarrhea in Adults

Initial Assessment and Red‑Flag Identification

Begin immediate oral rehydration with reduced‑osmolarity oral rehydration solution (65–70 mEq/L sodium, 75–90 mmol/L glucose); empiric antibiotics are not indicated for uncomplicated watery diarrhea in immunocompetent adults without recent international travel – strong recommendation. [21][22]
Fever ≥ 38.5 °C together with bloody or mucoid stools suggests invasive bacterial pathogens (e.g., Shigella, Campylobacter, invasive E. coli) and warrants empiric antibiotic therapy. [21][22]
Signs of sepsis (altered mental status, hypotension, tachycardia) require blood cultures and empiric broad‑spectrum antibiotics. [21][22]
Immunocompromised patients with severe illness have a lower threshold for initiating antibiotics and for diagnostic work‑up. [21][23]
Bloody diarrhea without fever must be screened for Shiga‑toxin‑producing E. coli (STEC O157:H7) before any antibiotics because antimicrobial therapy markedly increases the risk of hemolytic‑uremic syndrome. [21][22]23
Severe abdominal cramping or tenderness should prompt Shiga‑toxin testing. [21][22]
Altered mental status, inability to tolerate oral intake, or hypotension/shock indicate severe dehydration and mandate immediate intravenous fluid resuscitation. 23

Rehydration Strategy

Reduced‑osmolarity ORS (65–70 mEq/L sodium, 75–90 mmol/L glucose) is the first‑line therapy for mild‑to‑moderate dehydration. 23
Continue ORS until clinical dehydration resolves and diarrhea stops. 23
For severe dehydration, shock, or failure of oral rehydration, administer isotonic intravenous fluids (lactated Ringer’s or normal saline) immediately. 23
Maintain IV fluids until pulse, perfusion, and mental status normalize, then transition to ORS to replace remaining deficit. 23

Antimicrobial Therapy

Situations in Which Antibiotics Should NOT Be Used

Uncomplicated watery diarrhea without fever, blood, or recent travel – strong recommendation against empiric antibiotics. [21][22]
Suspected or confirmed STEC O157:H7 or Shiga‑toxin‑2‑producing E. coli – antibiotics increase hemolytic‑uremic syndrome risk. [21][23]
Asymptomatic contacts of patients with diarrhea. 23

Situations in Which Antibiotics Should Be Used

Fever with bloody diarrhea (bacillary dysentery) – presumptive Shigella therapy. 23
Suspected enteric fever with sepsis features – obtain blood, stool, and urine cultures before starting antibiotics. [21][23]
Immunocompromised patients with severe illness and bloody diarrhea. 23

Recommended Antibiotic Regimens (when indicated)

Azithromycin – preferred first‑line agent (single 500 mg dose for acute watery diarrhea; 1 g single dose for febrile dysentery) due to high fluoroquinolone resistance in Campylobacter in many regions.
Fluoroquinolones (ciprofloxacin 750 mg single dose or 500 mg BID × 3 days; levofloxacin 500 mg single dose or daily × 3 days) – second‑line if azithromycin unavailable or local susceptibility is favorable.
Third‑generation cephalosporin (ceftriaxone 50 mg/kg/day) for infants < 3 months with suspected bacterial etiology. 21

Symptomatic and Adjunctive Therapy

Loperamide may be used in immunocompetent adults with watery diarrhea after adequate rehydration (initial 4 mg, then 2 mg after each loose stool, max 16 mg/24 h); contraindicated if fever or bloody stools are present because of toxic‑megacolon risk, and never used in patients < 18 years. 23
Resume a normal, age‑appropriate diet immediately after rehydration; start with small, light meals and avoid fatty, heavy, spicy foods and caffeine. 23

Diagnostic Testing (Selective)

Obtain stool studies when any of the following are present: fever with bloody/mucoid stools, severe dehydration or illness, persistent fever, immunosuppression, suspected outbreak, or recent hospitalization/antibiotic exposure (to evaluate for C. difficile). [21][22]
Stool panel should include:
- Bacterial culture for Salmonella, Shigella, Campylobacter, Yersinia;
- Shiga‑toxin testing (or gene detection) to identify STEC;
- C. difficile toxin assay when recent healthcare exposure or antibiotics are noted. [21][22]
Blood cultures are indicated in infants < 3 months, any signs of septicemia, suspected enteric fever, or immunocompromised patients with systemic manifestations. [21][22]

Safety and Pitfall Avoidance

Never prioritize antimotility agents or antibiotics over rehydration – dehydration, not diarrhea, drives morbidity and mortality.
Never start antibiotics for bloody diarrhea before ruling out STEC with Shiga‑toxin testing. [21][22]
Never use loperamide when fever or bloody stools are present (risk of toxic megacolon). 23
Never prescribe empiric antibiotics for uncomplicated watery diarrhea – contributes to antimicrobial resistance without clinical benefit. 21
Never delay intravenous rehydration in severe dehydration while attempting oral rehydration. 23

Follow‑Up and Antibiotic Stewardship

If no clinical improvement within 48–72 hours, reassess for antimicrobial resistance, fluid/electrolyte disturbances, or non‑infectious etiologies and consider hospitalization.
Discontinue or modify antibiotic therapy once a specific pathogen is identified. 23

Rehydration and Symptomatic Management of Acute Watery Diarrhea

Fluid Replacement Guidelines

In patients with acute watery diarrhea, the total fluid intake should be calculated to exceed ongoing losses, defined as the sum of urine output, insensible losses (approximately 30–50 mL per hour), and stool losses. [24][25]

Antimotility Therapy

After adequate rehydration, loperamide may be used at an initial dose of 4 mg, followed by 2 mg every 2–4 hours or after each unformed stool, not to exceed a total of 16 mg per day. [25][26]

Dietary Recommendations

During the acute phase, patients should avoid lactose‑containing products, alcoholic beverages, and high‑osmolarity supplements. [27][28]

Management of Acute Watery Diarrhea in Otherwise Healthy Adults

1. Assessment and Contraindications

Exclude red‑flag features before prescribing loperamide – ensure the patient has no fever ≥ 38.5 °C, no visible blood or mucus in stool, no severe abdominal pain or distention, is ≥ 18 years old, is not immunocompromised, and has not taken recent antibiotics that could indicate Clostridioides difficile infection. Presence of any of these signs mandates avoidance of loperamide and consideration of stool testing or antibiotics. [29][30]
If any red‑flag is identified, do not use loperamide and pursue appropriate diagnostic work‑up. [29][30]

2. Rehydration

Oral rehydration solution (ORS) is the first‑line therapy; initiate it immediately and continue until clinical dehydration resolves and stools cease. [29][30]

3. Antimotility Therapy (Loperamide)

Indication – Loperamide may be added only after adequate rehydration and after confirming the absence of red‑flag features. [29][30]
Dosing regimen –
- Initial dose: 4 mg orally. [29][30][31][32]
- Maintenance: 2 mg after each unformed stool. [29][30][31][32]
- Maximum: 16 mg per 24 h (do not exceed). [29][30][31][32]
Efficacy – Loperamide reduces stool frequency and shortens the duration of acute watery diarrhea without prolonging the underlying illness. [29][30]
Evidence balance – Systematic reviews and randomized trials show that antimotility medication diminishes diarrhea and accelerates recovery in uncomplicated cases. [29][30]

4. Dietary Management

Resume a normal, age‑appropriate diet as soon as rehydration is complete; start with small, light meals and avoid heavy, fatty, spicy foods and caffeine. [29][30]
No evidence that solid food hastens or delays recovery in adults with acute watery diarrhea. [29][30]

5. Antibiotic Stewardship

Do not prescribe empiric antibiotics for uncomplicated acute watery diarrhea in immunocompetent adults without recent international travel. 30
Antibiotics are reserved for:
- Fever + bloody diarrhea (suggesting invasive bacterial infection). [29][30]
- Recent international travel with severe symptoms (traveler’s diarrhea). [29][30]
- Immunocompromised patients with severe illness. 30
- Suspected enteric fever with sepsis features. 30

6. Follow‑up and Safety Monitoring

Patients should be reassessed if: no improvement within 48 h, worsening symptoms, or development of warning signs such as severe vomiting, persistent fever, abdominal distention, or frank blood in stool. 30
Stop loperamide immediately if any of the following occur: fever ≥ 38.5 °C, bloody or mucoid stools, severe abdominal pain/distention, signs of ileus or toxic megacolon. [29][30]

7. Evidence Quality

Strong consensus from international gastroenterology guidelines (2001) supports the use of loperamide after rehydration in uncomplicated watery diarrhea. [29][30]
High‑quality evidence from the Infectious Diseases Society of America (IDSA) and the European Society for Medical Oncology (ESMO) guidelines (2018) corroborates safety and efficacy. [31][32]
Multiple randomized controlled trials demonstrate benefit without increased risk of complications when used appropriately. [29][30]

All statements are based on cited literature and reflect the strength of evidence where reported.

Management of Acute Diarrhea in Elderly Patients – Evidence‑Based Recommendations

Assessment of Dehydration and Red‑Flag Identification

Evaluate hydration status in older adults by checking skin turgor (prolonged tenting > 2 seconds indicates severe dehydration), mucous membrane dryness, mental status changes, orthostatic vital signs, and reduced urine output. Centers for Disease Control and Prevention (CDC) – MMWR Recommendations 33

Identification of Clostridioides difficile Infection

In patients with recent antibiotic exposure (within 3 months), recent hospitalization, or residence in a nursing home, obtain stool testing for C. difficile toxin to rule out infection. Infectious Diseases Society of America (IDSA) – Clinical Infectious Diseases 34

Indications for Stool Testing in Elderly Patients

Routine stool studies are not required for uncomplicated watery diarrhea in otherwise healthy older adults. IDSA – Clinical Infectious Diseases 34
Obtain stool studies when any of the following are present: fever with bloody or mucoid stools, severe dehydration or systemic illness, recent antibiotic use or healthcare exposure (to evaluate for C. difficile), diarrhea persisting > 7–10 days, or suspicion of an outbreak/multiple ill contacts. IDSA – Clinical Infectious Diseases 34

Dietary Recommendations – Lactose Management

During the acute phase of diarrhea, temporarily eliminate lactose‑containing foods (except yogurt and hard cheeses) because transient lactose intolerance is common. American Society of Clinical Oncology (ASCO) – Annals of Oncology 35

Antibiotic Therapy for Confirmed C. difficile Infection

First‑line treatment: oral vancomycin 125 mg four times daily for 10–14 days.
Alternative regimen (when vancomycin unavailable or contraindicated): metronidazole 500 mg three times daily for 10–14 days. American Society of Clinical Oncology (ASCO) – Journal of Clinical Oncology 36

Evidence‑Based Management of Acute Watery Diarrhea

Rehydration – Foundational Intervention

Reduced‑osmolarity oral rehydration solution (≈65–70 mEq/L sodium and 75–90 mmol/L glucose) is the cornerstone of therapy for acute watery diarrhea in immunocompetent adults, and empiric antibiotics are not indicated for uncomplicated cases. 37
Oral rehydration solution is the single most important intervention, preventing morbidity and mortality more effectively than any other treatment for acute watery diarrhea. 38

Etiology – Predominantly Viral

The majority of acute watery diarrhea episodes are viral; rotavirus accounts for about 25 % of pediatric cases, while Norwalk‑like viruses, enteric adenoviruses, astroviruses, and caliciviruses are also common causes. 39

Diagnostic Testing – Selective Indications

Stool testing should be obtained when any of the following are present: fever with bloody or mucoid stools; or diarrhea persisting longer than 7–10 days. 37
A recommended stool panel includes bacterial cultures for Salmonella, Shigella, Campylobacter, and Yersinia. 37

Critical Clinical Priorities

Rehydration must always take precedence over antimotility agents or antibiotics; dehydration—not diarrhea—is the primary driver of morbidity and mortality in acute watery diarrhea. 38