Treating diarrhoeaBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7097.1776 (Published 21 June 1997) Cite this as: BMJ 1997;314:1776
Severe community acquired diarrhoea calls for an antimicrobial drug, preferably a quinolone
- Sherwood L Gorbach, Professor of community health and medicinea
- a Tufts University School of Medicine, Boston, MA 02111, USA
Diarrhoea is a great equaliser. It afflicts all ranks, young and old, hale and infirm, with symptoms that range from mild discomfort to life threatening dehydration. The British Society for the Study of Infection recently published a helpful consensus statement on the management of infective gastroenteritis in adults.1 It provides a concise yet comprehensive account of diagnosis and treatment with fluid replacement, antidiarrhoeal agents, and antimicrobial drugs, especially the quinolones.
Since a consensus statement is, by definition, a compromise between the individual opinions of experts, such declarations, particularly those concerning treatment, tend to be rather conservative. It is easier to find disagreement among the assembled experts than universal acceptance of a specific treatment. As an individual commentator I have licence to express more bold opinions than those of the consensus statement, which are rather cautious concerning treatment.
My approach to treatment is based on two premises. Firstly, a person who is sufficiently ill with acute diarrhoea to seek medical attention wants to receive treatment that will provide prompt relief. Secondly, safe and effective drugs are available to provide prompt relief of acute gastroenteritis that causes unremitting call to stool.
In order to …