What are the risks and benefits of antibiotic treatment for bacterial gastroenteritis?

Updated: Jul 17, 2018
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: BS Anand, MD  more...
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Antibiotic treatment prolongs the carrier state and is associated with relapse; thus, treatment is not indicated for nontyphoid, uncomplicated diarrhea. Consider treatment for infants younger than 3 months and for high-risk patients, such as patients who are immunocompromised or who have sickle cell disease.

Ampicillin is recommended for drug-sensitive strains. Trimethoprim-sulfamethoxazole, fluoroquinolones,* or third-generation cephalosporins (fluoroquinolones are not recommended for use in children) are also acceptable alternatives. S typhimurium T104 is a multidrug-resistant organism. Sensitivities from the cultured specimens are important to guide therapy.

In July 2018, the FDA ordered ordered label changes for fluoroquinolones to strengthen warnings about the antibiotics' risks for mental health side effects and serious blood sugar disturbances. [41, 42]

Shigella species

Antibiotic treatment may shorten illness duration and shedding but does not prevent complications. Most mild infections will recover without antibiotics. Moderate to severe cases should be treated with antibiotics. Ampicillin is preferred for drug-sensitive strains. For ampicillin-resistant strains or in cases of penicillin allergy, trimethoprim-sulfamethoxazole is the drug of choice, although resistance does occur. Fluoroquinolones* may be considered in patients with highly resistant organisms.

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