How hospital physicians adhere to guidelines on management of diarrhea in adults has not been adequately assessed. The purposes of this study were to evaluate the management of acute diarrhea in adults and to assess the adherence of hospital physicians to the Manatsathit working party recommended guidelines. A cross sectional survey was carried out during May to July 2011 among physicians in 10 hospitals in Beijing, China. Data were collected for 400 patients (208 females and 192 males) with the mean age of (35.54-14.8) years. Overall, 357 (89.3%) patients presented with watery diarrhea and 43 (10.7%) patients presented with bloody diarrhea. Of 357 patients who needed fluid and electrolyte therapy, however, up to 114 (31.9%) patients were not ordered any fluid and electrolyte replacement; although only 28 (7.8%) actually supposed to use the antibiotics due to an age of higher than 65 years or being immunologically compromised, however, 186 (52.1%) were prescribed antibiotics which significantly deviated from the guidelines recommended by the Manatsathit working party. Antimotility drugs were only used in seven patients with watery diarrhea, which was in line with the guidelines. Hospital physicians in Beijing did not adhere well to the guidelines for the management of acute diarrhea. Physicians might need to be refreshed on the guidelines in this specific field.