IDSA has published in Clinical Infectious Diseases a new guideline on the detection and treatment of infectious diarrhea. New culture-independent tests are much more sensitive than traditional diagnostic methods in detecting the cause of infectious diarrhea, but because these tests are so sensitive and may detect multiple organisms, infectious disease expertise may be necessary to interpret the clinical significance and facilitate appropriate public health surveillance, according to the new guidelines. An accompanying editorial provides additional perspective from the clinical lab on culture-independent diagnostic tests.
Designed to guide primary care physicians and other healthcare providers who see most children and adults with diarrhea, the guidelines note that the majority of people with diarrhea do not need to be tested. Those who should be considered for diagnostic testing include children younger than five, the elderly, people who are immune-compromised and those with bloody diarrhea, severe abdominal pain, or tenderness or signs of sepsis.
The guidelines include seven tables that busy clinicians can quickly reference for information about the various ways people acquire the microbes, exposure conditions, post-infectious symptoms and clinical presentation, as well as recommended antimicrobial, fluid and nutritional management. The tables also help clinicians assess when a person with diarrhea should be tested and provide treatment considerations. Physicians should ensure that children with mild to moderate dehydration, and children and adults with acute diarrhea and those with mild to moderate dehydration associated with vomiting or severe diarrhea be given oral rehydration solution if tolerated, progressing to intravenous rehydration if oral rehydration is not tolerated.
The guidelines also underscore the vital role primary care clinicians can play in identifying an outbreak.
In addition to lead authors Andi L. Shane, MD, MPH, MSc and Larry Pickering, MD, the guidelines panel includes: J. Robert Cantey, MD; Allen C. Cheng, PhD; John A Crump, MD; Karen Kotloff, MD; Joanne M. Langley, MD; Rajal K. Mody, MD; Theodore S. Steiner, MD; Phillip I. Tarr, MD; Christine Wanke, MD; and Cirle Alcantara Warren, MD.
This guideline will be available in a smartphone format and a pocket-sized quick-reference edition on the IDSA website at www.idsociety.org.
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