Infectious Diarrhoea - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  --
Last review: 01/03/2016  
Next review: 01/02/2019  
Clinical Guideline
ID: 2250 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2016  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Infectious Diarrhoea



Infectious diarrhoea

Antibiotic therapy not indicated unless patient systemically unwell 1C
Send Stool sample for M,C and S (and Rotavirus Antigen for Children <5 years)
Request Ova, Cysts and Parasites (OCP) if history of exposure/travel to endemic area
Request Viral PCR if institutional viral gastroenteritis outbreak suspected or if required on basis of clinical history

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Principles of Treatment

  1. This guidance is based on the best available evidence but its application must be modified by professional judgement.

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Record: 2250
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Infectious Diarrhoea

Target patient group:
Target professional group(s): Primary Care Doctors
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.

Evidence base

Grading of guidance recommendations

The strength of each recommendation is qualified by a letter in parenthesis.

Study design


Good recent systematic review of studies


One or more rigorous studies, not combined


One or more prospective studies


One or more retrospective studies


Formal combination of expert opinion


Informal opinion, other information


Letters indicate strength of evidence:
A+ = systematic review: D = informal opinion

Infectious diarrhoea

  1. The Griffin Report. Report of the Independent Investigation Committee June 2010. Review of the major outbreak of E. coli O157 in Surrey, 2009 an evaluation of the outbreak and its management, with a consideration of the regulatory framework and control of risks relating to open farms. 2010 Accessed 23.09.14.
  2. Farthing M, Feldman R, Finch R, Fox R, Leen C, Mandal B, Moss P, Nathwani D, Nye F, Percival A, Read R, Ritchie L, Todd WT, Wood M. The management of infective gastroenteritis in adults. A consensus statement by the British Society for the Study of Infection. J Infect 1996;33:143-52. RATIONALE: Empirical treatment for patients well enough to be managed in primary care is not recommended because the majority of illnesses seen in the community do not have an identifiable bacterial cause. In addition, an RCT of quinolones as empiric therapy found no benefit in patients whose stool cultures were negative.
  3. Public Health England and the British Infection Association recommend that, if campylobacter is strongly suspected as the cause of diarrhoea, consider empirical treatment with clarithromycin. Quinolones are not recommended because there is increasing resistance of campylobacter to quinolones, and broad spectrum antibiotics such as quinolones are not recommended for empirical therapy because they are associated with an increased risk of Clostridium difficile, MRSA, and antibiotic resistance including resistant UTIs.
  4. E. coli O157 Independent Investigation Committee. Review of the major outbreak of E. coli O157 in Surrey, 2009. Accessed 23.09.14. The Griffin report recommends that E coli O157 should be suspected in any child presenting with bloody diarrhoea.

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Document history

LHP version 1.0

Related information

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