Seventy adults in the United States with acute diarrhea who were attending classes in Guadalajara, Mexico, enrolled in a double-blind placebo-controlled treatment study of an anticholinergic drug, mepenzolate bromide (MZB). Thirty-five patients received MZB (50 mg) and 35 received placebo each taken 4 times daily for 48 hours. No significant difference was detected between the MZB- and placebo-treated patients in symptoms or in the frequency or character of stools. Recovery rates of 24.1% and 31% for placebo- and MZB-treated patients were similar. Despite the occurrence of anticholinergic side effects in 51% of MZB- versus 14% of placebo-treated patients (P less than 0.001), therapeutic efficacy was not detected. We do not recommend anticholinergic drugs for therapy in acute infectious diarrhea.