What are antimicrobial treatment options for bacterial gastroenteritis?

Updated: Jul 17, 2018
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: BS Anand, MD  more...
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Answer

Standard antimicrobial therapies for bacterial gastroenteritis include the following:

  • Aeromonas species: Cefixime and most third- and fourth-generation cephalosporins

  • Bacillus species: None necessary for self-limited gastroenteritis; vancomycin and clindamycin for severe disease

  • Campylobacter species: Erythromycin; therapy started more than 4 days after onset of symptoms appears to produce no clinical benefit

  • C difficile: Discontinuance of the potential causative antibiotics; if this is impossible or ineffective, oral metronidazole or (in seriously ill patients who do not respond to metronidazole) vancomycin

  • Clostridium perfringens: None

  • Listeria species: None necessary unless invasive disease occurs; ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) for invasive disease

  • Plesiomonas species: TMP-SMX or any cephalosporin

  • Vibrio cholerae: Tetracycline; in resistant cases, TMP-SMX, erythromycin, doxycycline, chloramphenicol, or furazolidone

  • Yersinia species: TMP-SMX, fluoroquinolones, or aminoglycosides; reserved for complicated cases

  • E coli: TMP-SMX if diarrhea is moderate or severe; for systemic complications, a parenteral second-generation or third-generation cephalosporin

  • Salmonella species: None necessary for nontyphoid, uncomplicated diarrhea but may be considered for infants younger than 3 months and for high-risk patients (eg, those who are immunocompromised or have sickle cell disease); for drug-sensitive strains, ampicillin or, alternatively, TMP-SMX, fluoroquinolones, or third-generation cephalosporins

  • Shigella species: None necessary for most mild infections; for moderate-to-severe cases, ampicillin for drug-sensitive strains and TMP-SMX for ampicillin-resistant strains or in cases of penicillin allergy; fluoroquinolones may be considered in patients with highly resistant organisms


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