| General recommendations on force health protection strategies |
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1
Providers should support and implement Combatant Command FHP Guidance related to prevention of food and waterborne disease (Ungraded consensus-based statement)
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2
In deployed settings, surveillance and early treatment are important. Therefore, those with vomiting, watery diarrhea, or bloody stools should report to medical personnel at onset of symptoms (Grade 1B)
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3
In scenarios where access to a medical provider may be limited, providing individual self-treatment medications (including antibiotics) to a deploying unit should be considered (Grade 1B)
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4
More than one individual presenting from a unit with a vomiting predominant illness, with or without diarrhea, should prompt preventive medicine assistance to rule out norovirus (Ungraded consensus-based statement)
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| Non-antibiotic management of acute diarrheal illness during deployment |
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5
Prevention of dehydration is a critical aspect of diarrhea management. Early use of oral fluids and electrolytes should be encouraged (Grade 1A)
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6
For those reporting mild watery diarrhea, the use of loperamide or bismuth subsalicylate or watchful waiting are each reasonable options. Failure to improve or worsening of symptoms should prompt re-evaluation (Grade 1A)
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| Antibiotic Therapy of acute watery diarrheal illness during deployment |
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7
For those reporting moderate or severe watery diarrhea, early antibiotic therapy combined with loperamide is recommended (Grade 1A)
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8
For those who are treated for watery diarrhea, single-dose antibiotic therapy is recommended (Grade 1A)
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9
Azithromycin 500 mg is recommended for use as a first-line agent for treatment of watery diarrhea in all regions of the world (Grade 1B)
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10
Levofloxacin 500 mg is recommended as an alternative first-line agent for treatment of watery diarrhea, except in regions of the world where there is resistance (Grade 1A)
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11
There are limited data suggesting single-dose rifaximin 1650 mg may be an alternative to the other single-dose antibiotic therapies in treatment of watery diarrhea where first-line agents cannot be used (Grade 1C, with remarks)
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| Antibiotic therapy of Dysentery and Febrile Diarrhea |
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12
For those reporting fever greater than 101°F and/or bloody stools, single-dose azithromycin 1000 mg is recommended in all regions of the world (Grade 1B)
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13
Loperamide should not be used as a standalone agent for dysentery or febrile diarrhea (Grade 1B)
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14
When azithromycin 1000 mg is used for dysentery or febrile diarrhea, loperamide may be safely used in combination (Grade 2C)
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15
Levofloxacin 500 mg for three days may be used as an alternative therapy to azithromycin in the treatment of dysentery/febrile diarrhea, except in areas where there is resistance (Grade 1B)
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| Follow-up and diagnostic testing |
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16
Among those that fail to improve in 72 hours or in whom illness worsens after 24 hours, alternative antibiotic regimen, and expert consultation should be considered (Ungraded consensus-based statement).
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17
Advice on specific diagnostic testing should be sought in the following situations: outbreaks, patients having diarrhea for more than 2 weeks, or treatment failures (Ungraded consensus-based statement)
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