Acute Diarrhea in Adults: Modern Treatment Strategies for Intestinal Infections

Acute diarrhea is a common condition characterized by a sudden increase in stool frequency and/or a change in its consistency to a more liquid state. Although in most cases acute diarrhea resolves on its own and does not require specific treatment, some of its forms, especially those caused by intestinal infections, can pose a serious health threat and require immediate medical intervention. Understanding the causes and modern treatment approaches is critical for effective recovery and the prevention of complications in adults.

When Does Acute Diarrhea Require Special Attention?

Most cases of acute diarrhea are caused by viral infections and resolve within a few days. However, if diarrhea is accompanied by a high fever, severe abdominal pain, blood or mucus in the stool, signs of dehydration, or lasts for more than a few days, it is necessary to consult a doctor. These symptoms may indicate a bacterial infection or another serious medical condition.

Bacterial Intestinal Infections: Serious Threats

Among the bacterial infections causing acute diarrhea, those requiring specific and often intensive treatment occupy a special place:

• Recurrent Clostridioides difficile Infection (rCDI): This infection often occurs after a course of antibiotics that disrupt the normal intestinal microflora. Clostridioides difficile produces toxins that cause inflammation of the colon and severe diarrhea. To prevent rCDI recurrences in adults, especially in patients with comorbidities such as irritable bowel syndrome, fecal microbiota-based products are actively used. For example, REBYOTA®, a product containing live fecal microbiota, is FDA-approved for the prevention of rCDI following standard antibiotic therapy [3].
• Infections Caused by Carbapenem-Resistant Enterobacterales (CRE): These are extremely dangerous bacterial infections characterized by high antibiotic resistance and significant mortality. A study conducted in Saudi Arabia showed that overall mortality among patients with CRE infections was 43.3%, with Klebsiella pneumoniae identified in 96% of cases. The treatment of such infections presents a complex challenge, and the choice between antibiotic monotherapy and combination therapy requires a careful approach [8].

Modern Approaches to Treating Intestinal Infections

The treatment of acute diarrhea caused by an infection depends on its causative agent and the severity of the patient's condition:

• Antibiotic Therapy: For confirmed bacterial infections (e.g., salmonellosis, shigellosis, certain forms of escherichiosis), antibiotics may be prescribed. However, their use must be justified, as uncontrolled use can lead to the development of resistance and disruption of the intestinal microflora. In the case of CRE infections, the choice of antibiotics is extremely limited, and physicians are forced to use last-line reserves, carefully weighing the risks and benefits of mono- or combination therapy [8].
• Microflora Restoration: To combat recurrent Clostridioides difficile infections, fecal microbiota transplantation (FMT) is an effective method. Products containing live microbiota help restore a healthy balance of intestinal bacteria by crowding out pathogenic microorganisms [3].
• Symptomatic Treatment and Rehydration: Regardless of the cause of diarrhea, it is extremely important to prevent dehydration. This is achieved by taking a sufficient amount of fluid, including rehydration solutions. Drugs that slow down intestinal motility may be used with caution, especially in the absence of signs of a bacterial infection.

Special Patient Groups and Complex Cases

Certain groups of patients require special attention when experiencing acute diarrhea:

• Elderly and Immunosuppressed Patients: In elderly individuals and patients with weakened immune systems (e.g., those taking corticosteroids), infections can be more severe and present with atypical manifestations. In rare cases, co-infections may occur, such as simultaneous infection with Enterobius vermicularis and Helicobacter pylori, which requires an integrated approach to diagnosis and treatment [6].
• Patients with Inflammatory Bowel Disease (IBD): IBD flare-ups (Crohn's disease, ulcerative colitis) can manifest as severe diarrhea requiring hospitalization. In such cases, it is important to differentiate a flare-up of the underlying disease from an acute intestinal infection, as the treatment approaches will differ radically [5].

The Importance of Timely Diagnostics

Accurate diagnosis is the key to effective treatment. A physician may order a stool test to identify the infectious agent (bacteria, viruses, parasites), as well as other tests to assess the patient's general condition and rule out other causes of diarrhea. Self-treatment, especially with antibiotics, without an accurate diagnosis can be not only ineffective but also dangerous.

Conclusion

Acute diarrhea in adults can range from a mild, self-limiting condition to a serious threat requiring immediate medical attention. Understanding when to see a doctor and knowing modern treatment methods, especially regarding serious infections such as Clostridioides difficile and carbapenem-resistant Enterobacterales, is crucial for health. Always consult a medical professional for an accurate diagnosis and appropriate treatment.

Sources

• 1. The Impact of Hangeshashinto on Symptoms and Gut Microbiota in Diarrhea-type Irritable Bowel Syndrome: A Retrospective Analysis. https://pubmed.ncbi.nlm.nih.gov/39882236/
• 2. Clinical and cost effectiveness of nurse led-structured management of diarrhoea predominant irritable bowel syndrome in primary care (Lincolnshire POACHER study); a randomised control trial. https://pubmed.ncbi.nlm.nih.gov/41922986/
• 3. Safety and Efficacy of Fecal Microbiota, Live-jslm to Prevent Recurrent Clostridioides difficile Infection in Participants With Irritable Bowel Syndrome. https://pubmed.ncbi.nlm.nih.gov/40784972/
• 4. Ménétrier disease: a rare cause of severe chronic diarrhea difficult to diagnose with response to treatment with octreotide. https://pubmed.ncbi.nlm.nih.gov/39235177/
• 5. AGA Clinical Practice Update on Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review. https://pubmed.ncbi.nlm.nih.gov/41579011/
• 6. Enterobius vermicularis and Helicobacter pylori coinfection in a geriatric patient on long-term steroids: A case report. https://pubmed.ncbi.nlm.nih.gov/41997297/
• 7. Current state of the non-pharmacological management of irritable bowel syndrome: an up-to-date review of the literature. https://pubmed.ncbi.nlm.nih.gov/39610348/
• 8. Clinical outcomes and treatment effectiveness in patients with carbapenem-resistant Enterobacterales infections: a multicenter retrospective cohort study. https://pubmed.ncbi.nlm.nih.gov/42558620/

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult a qualified specialist for the diagnosis and treatment of any medical conditions.