Gastroenteritis

  • Avoid anti-motility agents until you have ruled out C. difficile or E. coli 0157:H7 as the cause.
  • Do not use bismuth subsalicylate with quinolones as binding decreases quinolone absorption.

MILD-MODERATE

Antibiotic therapy is NOT recommended unless symptoms severe or prolonged.

SEVERE

Severity criteria (one or more):

  • 6 or more diarrheal episodes per day
  • bloody diarrhea
  • persistent diarrhea (greater than 3 days)

If patient has a sepsis presentation, treat as sepsis with a GI source.

  • Culture and C. difficile toxin testing is recommended. C. difficile can be a community-associated infection and is not always associated with recent antibiotic use or hospital exposure.

Bloody diarrhea in afebrile patients should increase suspicion of E. coli 0157:H7. No antibiotic therapy recommended as it may enhance toxin release and increase risk of hemolytic uremic syndrome (HUS).

  • Consider Campylobacter spp. in persons with travel history.

Recommended Empiric Therapy (5 days)

Ciprofloxacin 500 mg PO bid
Alternative
TMP/SMX 1 DS tab PO bid

If travel history and suspicion of Campylobacter spp.

Clarithromycin 500 mg PO BID, OR Erythromycin 500 mg PO QID
Alternative
Ciprofloxacin 500 mg PO bid

Other Therapy Guidelines