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Acute Infectious Diarrhea Protocol (Philippine CPG)

Gastrointestinal

1. Assessment & Diagnosis

  • Definition: Passage of 3 or more loose/watery stools in 24 hours.
  • Key Goal: Assess the level of dehydration immediately.
  • No Dehydration: Alert and thirsty.
  • Some Dehydration: Restless/irritable, sunken eyes, drinks eagerly.
  • Severe Dehydration: Lethargic/unconscious, unable to drink, skin pinch goes back very slowly.
  • Diagnostic Tests: Routine stool microscopy (fecalysis) is NOT recommended for acute watery diarrhea unless cholera or dysentery (bloody stool) is suspected.

    • 2. Management

  • Rehydration (The Priority):
  • Plan A (Home): Give Oral Rehydration Salts (ORS) after every loose stool.
  • Plan B (Some Dehydration): ORS supervised in the clinic (75ml/kg over 4 hours).
  • Plan C (Severe): Requires IV fluids (Lactated Ringer's) immediately.
  • Zinc Supplementation: Give Zinc to all children <5 years old for 10-14 days to reduce duration and severity.
  • Antibiotics: NOT RECOMMENDED for routine acute gastroenteritis. Antibiotics are only indicated for confirmed Cholera, Shigella (bloody diarrhea), or Amoebiasis.
  • Diet: Continue feeding (breastfeeding or usual diet). Do not withhold food.
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    Warning Signs

    DANGER SIGNS (Refer Immediately)

  • Severe Dehydration: Lethargy, unconsciousness, or inability to drink.
  • Blood in stool (Dysentery).
  • Persistent Vomiting (Unable to keep ORS down).
  • High Fever or severe abdominal pain.
  • Young Infants: <2 months old with diarrhea.

    • Reference

    1. PSMID, PSPGHN, PIDSP, PAFP (Joint Philippine Medical Societies) (2016). Philippine Clinical Practice Guideline for Acute Infectious Diarrhea (Pocket Guide).
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