Guidelines for adults on self-medication for the treatment of acute diarrhoea D. WINGATE*, S. F. PHILLIPS  , S. J. LEWIS à , J.-R. MALAGELADA§, P. SPEELMAN ± , R. STEFFEN**, & G. N. J. TYTGAT    *St Bartholomew's and the Royal London School of Medicine and Dentistry, Gastrointestinal Science Research Unit, London, UK;  Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota, USA; àDepartment of Internal Medicine, University Hospital of Wales, Cardiff, UK; §Digestive Diseases, Hospital General Val d'Hebron, Autonomous University of Barcelona, Spain; ±Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands; **Division of Communicable Diseases & WHO CC for Travellers' Health, Institute of Social and Preventive Medicine (ISPM), University of Zurich, Zurich, Switzerland; and   Department of Gastroenterology±Hepatology, Academic Medical Centre, Amsterdam, the Netherlands Accepted for publication 14 January 2001 INTRODUCTION Acute diarrhoea is a common af¯iction, even among adults. The episodes are usually brief and self-limiting, but the symptoms can be distressing and incapacita- ting. Consequently, medication to relieve the symptoms is frequently sought and often purchased without prescription. The choice is usually based on the recommendation of pharmacists and nurses, which in turn, is derived from guidelines by regulatory medical and pharmaceutical authorities. A survey of `of®cial' guidelines, however, revealed a wide variation in the regimens that are recommended (Table 1). Scrutiny of the many Web sites offering advice on the manage- ment of acute diarrhoea, or advice to travellers, SUMMARY Acute uncomplicated diarrhoea is commonly treated by self-medication. Guidelines for treatment exist, but are inconsistent, sometimes contradictory, and often owe more to dogma than evidence. An ad hoc multidisciplinary group has reviewed the literature to determine best practice. In general it is recognized that treatment of acute episodes relieves discomfort and social dysfunction. There is no evidence that it prolongs the illness. Self- medication in otherwise healthy adults is safe. Oral loperamide is the treatment of choice. Older anti- diarrhoeal drugs are also effective in the relief of symptoms but carry the risk of unwanted adverse effects. Oral rehydration solutions do not relieve diarrhoea, and confer no added bene®t for adults who can maintain their ¯uid intake. Probiotic agents are, at present, limited in ef®cacy and availability. Antimicrobial drugs, available without prescription in some countries, are not generally appropriate for self- medication, except for travellers on the basis of medical advice prior to departure. Medical intervention is recommended for the management of acute diarrhoea in the frail, the elderly (> 75 years), persons with concurrent chronic disease, and children. Medical intervention is also required when there is no abatement of the symptoms after 48 h, or when there is evidence of deterioration such as dehydration, abdominal distension, or the onset of dysentery (pyrexia > 38.5 °C and/or bloody stools). Correspondence to: Professor D. Wingate, St Bartholomew's and the Royal London School of Medicine and Dentistry, Wingate Institute, 26 Ash®eld Street, London E1 2AJ, UK. E-mail: D.L.Wingate@mds.qmw.ac.uk Aliment Pharmacol Ther 2001; 15: 773±782. Ó 2001 Blackwell Science Ltd 773