What are the goals of drug treatment for bacterial gastroenteritis?

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

The goals of pharmacotherapy in cases of gastroenteritis are to reduce morbidity and to prevent complications. The following is a list of standard antimicrobial therapies for bacterial gastroenteritis (although, as previously stated, many conditions are self-limited and require no therapy):

  • Aeromonas species - Use cefixime and most third-generation and fourth-generation cephalosporins

  • Bacillus species - No antibiotics are necessary for self-limited gastroenteritis, but vancomycin and clindamycin are first-line drugs for severe disease

  • Campylobacter species - Erythromycin may shorten the illness duration and shedding; delaying therapy beyond 4 days from the onset of symptoms appears to produce no clinical benefit

  • C difficile - Discontinue potential causative antibiotics; if antibiotics cannot be stopped or this does not resolve the diarrhea, use oral metronidazole or vancomycin (vancomycin is reserved for seriously ill patients whose condition does not respond to metronidazole)

  • C perfringens - Do not treat with antibiotics

  • Listeria species - No antibiotics are needed unless invasive disease occurs; ampicillin and Bactrim are first-line drugs for invasive disease

  • Plesiomonas species - Use trimethoprim-sulfamethoxazole or any cephalosporin

  • V cholerae - Tetracycline is the usual antibiotic of choice, but resistance to it is increasing; other antibiotics that are effective when V cholerae is sensitive to tetracycline include cotrimoxazole, erythromycin, doxycycline, chloramphenicol, and furazolidone

  • Yersinia species - Treatment (ie, trimethoprim-sulfamethoxazole, fluoroquinolones,* aminoglycosides) does not shorten the disease duration and should be reserved for complicated cases

* Note that fluoroquinolone resistance in Salmonella is increasingly being reported worldwide, with several molecular mechanisms described. [40]


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