What is the role of antimotility agents (AMAs) in the treatment of acute infectious diarrhea?
Most episodes of acute diarrhea are self-limited, lasting less than 24 hours, and do not require AMAs. For longer lasting diarrheal illnesses, these agents may decrease total diarrhea duration, thus improving quality of life. In general, AMAs are safe for use in adults with the following caveats: they should be avoided if the patient is critically ill, has a known or suspected C. difficile or E. coli O157:H7 infection, fever, or dysentery. AMAs should also be avoided in children younger than 3 years because of an increased number of adverse events in this population. When combined with antimicrobials for travelers’ diarrhea AMAs can shorten illness duration from a 3- to 5-day illness to less than 24 hours, particularly for those with more frequent episodes of pretreatment diarrhea.