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Antimicrobial Recommendations for Infectious Diarrhea |
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Adapted from Guerrant et al.., IDSA Guidelines for management of Infectious Diarrhea (see . Infect. Dis. Pharmacotherapy 2000; vol 4 suppl. 2 , p31)
DS = Co-trimoxazole double strength = TMP / SMX 160 / 800 mg.
FQN = fluoroquinolone |
|
Bug |
Drug |
 Shigella |
DS bid x 3 days if sensitive; or FQN (300 mg ofloxacin or 500 mg ciprofloxacin bid x 3 days) .
Because up to 20% of isolates from foreign travelers are co-trimox resistant and FQN resistance is rare, a FQN is preferred for initial therapy of travel-related shigellosis.
Note that FQNs are not approved for pediatric use in the U.S.
|
 Salmonella, non-typhoid |
Antimicrobial therapy is not recommended rountinely, but if the symptoms are severe or if the patients is <3 months or >50 years old or with prostheses, valvular heart disease, severe atherosclerosis, malignancy or uremia, DS or FQN (based on sensitivity) as above bid x 7 days |
| Campylobacter |
Erythromycin 500mg bid x 5 days
[Antibiotics are most effective if given early in course of illness.] |
| Enterotoxigentic E. coli |
DS bid x 3days if sensitive or FQN (300 mg ofloxacin or 500 mg ciprofloxacin bid x 3 days). |
| Enteropathogentic E. coli |
As above |
| Enteroinvasive E. coli |
As above |
 Enteroaggregative E. coli |
Unknown |
| Enterohemorrhagic E. coli |
Avoid antimotility drugs; role of antibiotics unclear. |
| Aeromonas/Plesiomonas |
DS bid x 3 days if sensitive or FQN (300 mg ofloxacin, 400 mg norfloxacin or 500 mg ciprofloxacin bid x 3 days). |
| Yersinia |
Antibiotics are not usually required; deferoxamine therapy should be withheld. With severe infections or associated bacteremia, treat as immunocomprised hosts using combinations therapy with doxycycline, aminoglycoside, DS, or FQN. |
| Vibrio |
Doxycyline 300mg single dose, or tetracycline 500mg qid x 3 days, or DS bid x 3 days , or ingle dose of a FQN |
| Toxigenic C. difficile |
Offending antibiotic should be discontinued if possible; metronidazole 250 -750 mg tid x10 days |
| Giardia |
Metronidazole 250-750 mg tid x 10 days |
| Cryptosoporidium |
If severe, consider paromomycin 500 mg tid x 7 days. In immuno-compromised hosts, paromomycin 500 mg tid x 14 -28 days, then bid if needed.
Highly active antiretroviral therapy including a protease inhibitor is warranted in patients with AIDS |
| Isospora |
DS bid x 7 days. In patients with AIDS, DS qid x 10 days followed by DS thrice weekly or sulfadoxine 500mg plus pyrimethamine 25 mg once weekly indefinitely. |
| Cyclospora |
DS bid x 7 days. In AIDS, DS qid x 10 days followed by thrice weekly DS indefinitely. |
| Microsporidiosis |
Albendazole 400mg bid x 3 - 4 wks.
Highly active antiretroviral therapy including a protease inhibitor is warranted in patients with AIDS |
| Entamoeba histolytica |
Metronidazole 750mg tid x 7 days, plus either diiodohydroxyquin 650mg tid x 20 days or paromomycin 500mg tid. |
