Acute diarrhea is defined as having at least 3 liquid stools per day for less than 2 weeks. It can be caused by viruses, bacteria, or parasites and is transmitted through direct or indirect contact with contaminated food, water, or surfaces. The main risks of acute diarrhea are dehydration and malnutrition. Treatment involves oral rehydration with fluids and electrolytes to prevent and treat dehydration. Zinc supplements are also given to children under 5 to reduce duration and recurrence of diarrhea. Antimicrobial treatment may be needed for specific cases of cholera or giardiasis. Prevention relies on breastfeeding, proper food preparation and storage, access to clean water, and good hygiene practices.

1. ACUTE DIARRHEA
 Acute diarrhea is defined as at least 3 liquid stools per day for less than 2 weeks.
 There are 2 clinical types of acute diarrhea:
 Diarrhea without blood, caused by viruses in 60% of cases (rotavirus, enterovirus),
bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, non-Typhi Salmonella,
Yersinia enterocolitica) orparasites (giardiasis). Diseases,such as malaria, acute otitis
media, respiratory tract infections, etc. can be accompanied by this type of diarrhea.
 Diarrhea with blood, caused by bacteria (Shigella in 50% of cases, Campylobacter
jejuni, enteroinvasive or enterohaemorrhagic Escherichia coli, Salmonella) or
parasites (intestinal amoebiasis). Infectious diarrheas are transmitted by direct
(dirty hands) or indirect (ingestion of contaminated water or food) contact. The high
mortality rate from diarrheal diseases, even benign, is due to acute dehydration and
malnutrition. This can be prevented by adequate rehydration and nutrition.
CLINICAL FEATURES
 First assess for signs of dehydration (see Dehydration).
 Then look forother signs:
 profuse watery diarrhea (cholera, enterotoxigenic E. coli),
 repeated vomiting (cholera),
 fever (salmonellosis, viral diarrhea),
 presence of red blood in stools: see also Shigellosis and Amoebiasis.
 In a patient over 5 years with severe and rapid onset of dehydration, suspect cholera.
TREATMENT
GENERAL PRINCIPLES:
 Prevent or treat dehydration: rehydration consists of prompt replacement of fluid and
electrolyte losses as required, until the diarrhea stops.
 Administer zinc sulfate to children under 5 years.
 Prevent malnutrition.
 Do not systematically administer antimicrobials: only certain diarrheas require antibiotics.
 Do not administer anti-diarrheal drugs or antiemetics.
 Treat the underlying condition if any (malaria, otitis, respiratory infection, etc.).
PREVENTION ANDTREATMENTOFDEHYDRATION
PREVENTION OFMALNUTRITION
 Continue unrestricted normal diet. In breastfed children, increase the frequency of feeds.
Breast milk does not replace ORS. ORS should be given between feeds.
ZINC SUPPLEMENTATION
 Zinc sulfate is given in combination with oral rehydration solution in order to reduce the
duration and severity of diarrhea, as well as to prevent further occurrences in the 2 to 3 months
after treatment: zinc sulfate PO
 Children under 6 months: 10 mg (½ tablet) once daily for 10 days
 Children from 6 months to 5 years: 20 mg (1 tablet) once daily for 10 days

2.  Place the half-tablet or full tablet in a teaspoon, add a bit of water to dissolve it, and give
the entire spoonful to the child.
ANTIMICROBIAL TREATMENT
Diarrhea without blood
 Most acute diarrheas are caused by viruses unresponsive to antimicrobials. Antimicrobials
can be beneficial in the event of cholera or giardiasis.
 Cholera: the most important part of treatment is rehydration. In the absence of resistance
(perform antibiotic-sensitivity testing at the beginning of an outbreak), antibiotic treatment
shortens the duration of diarrhea. See the guide Management of a cholera epidemic, MSF.
 Giardiasis: see Intestinal protozoan infections (see page 139), Chapter 6.
Diarrhea with blood
 Shigellosis is the most frequentcauseofbloodydiarrhea(amoebiasisis muchless common). If there
is no laboratory diagnosis to confirm the presence of amoebae, first line treatment is for shigellosis.
 Amoebiasis: antiparasitic treatment only if motile Entamoeba histolytica amoebae are found in
stools or if a correct shigellosis treatment has been ineffective.
PREVENTION
 Breastfeeding reduces infant morbidity and mortality from diarrhea and the severity of
diarrhea episodes.
 When the child is weaned preparation and storage of food are associated with the risk of
contamination by fecal micro-organisms: discourage bottle-feeding; food must be cooked
well; milk or porridge must never be stored at room temperature.
 Access to sufficient amounts of clean water and personal hygiene (washing hands with
soap and water before food preparation and before eating, after defecation etc.) are
effective methods of reducing the spread of diarrhea.
 In countries with a high rotavirus diarrhea fatality rate, the WHO recommends routine
Rotavirus vaccination in children between 6 weeks and 24 months of age.