Diagnosis of Bacterial Diarrhea
Most bacterial and nonbacterial enteropathogens produce nonspecific acute watery diarrhea. The rate of underreporting of cases of acute watery diarrhea that are caused by detectable enteric pathogens, including most cases of diarrhea caused by bacteria such as salmonella and campylobacter is substantial. Indications for stool culture include the presence of severe diarrhea (passage of six or more unformed stools per day), diarrhea of any severity that persists for longer than a week, fever, and multiple cases of illness that suggest an outbreak. Dysentery, with passage of blood and mucus in stools, suggests possible bacterial colitis, and stool samples are recommended. Stool cultures are not routinely recommended in most cases of watery diarrhea or traveler's diarrhea because of a low yield of bacterial pathogens.
Recommended treatment for bacterial diarrhea
For all cases of diarrhea, attention to fluid and electrolyte replacement is fundamental. Available data in children with acute diarrhea do support the continuation of oral feeding during the illness. Antimotility drugs such as loperamide and diphenoxylate hydrochloride, can reduce the number of stools passed and may be useful in controlling the stool rate with watery diarrhea. They should not be used without concomitant antibacterial therapy in patients with fever or dysentery in whom the drug may lead to increased contact time of the enteropathogen with the gut mucosa. Therapy with antimicrobial agents is important in most cases of diarrhea caused by invasive or inflammatory bacterial pathogens and is useful in other noninvasive forms of bacterial diarrhea.