From the Guidelines
Bacterial gastroenteritis should be managed with supportive care, including fluid and electrolyte replacement, and antibiotics should only be used in specific cases, such as Shigella, Campylobacter, or severe Salmonella, with regimens like ciprofloxacin or azithromycin, as recommended by guidelines 1.
Treatment Approach
The primary approach to treating bacterial gastroenteritis involves supportive care to prevent dehydration, with oral rehydration solutions like Pedialyte or homemade solutions being recommended for mild cases. Severe cases may require intravenous fluids.
- Oral rehydration solutions are preferred for mild cases
- Intravenous fluids may be necessary for severe cases
- Antibiotics are not routinely prescribed but may be necessary for specific infections
Antibiotic Use
Antibiotics may be necessary for specific infections, but their use should be guided by the severity of the infection and the causative organism.
- Ciprofloxacin 500mg twice daily for 3-5 days or azithromycin 500mg once daily for 3 days are common regimens
- Antibiotic selection should consider local resistance patterns, as noted in guidelines 1
- The use of broad-spectrum antibiotics like ticarcillin-clavulanate, cefoxitin, ertapenem, moxifloxacin, or tigecycline may be considered for complicated intra-abdominal infections, but their use should be judicious due to concerns about resistance 1
Prevention and Management
Prevention of bacterial gastroenteritis involves proper food handling, thorough cooking of meats, washing fruits and vegetables, and good hand hygiene.
- Proper food handling and cooking can prevent many cases of bacterial gastroenteritis
- Good hand hygiene is crucial in preventing the spread of infection
- Most cases resolve within 3-7 days with proper hydration, but persistent symptoms or severe signs warrant medical attention 1
From the Research
Bacterial Gastroenteritis Treatment
- The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution 2.
- Antiemetics can be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 2.
- The World Health Organization recommends a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis, but modifications such as low osmolarity, rice-based, and addition of probiotics, prebiotics, and/or zinc have been proposed to increase tolerability and shorten the duration of diarrhea 3.
Oral Rehydration Therapy
- Oral rehydration therapy is an effective and inexpensive treatment for dehydration associated with gastroenteritis, and it allows parents to be involved in their children's care 4.
- Oral rehydration therapy takes advantage of the remaining intact absorptive cells in the intestine, which are not destroyed by viral pathogens 4.
- A study comparing oral with intravenous therapy for treating dehydration due to acute gastroenteritis in children found that oral rehydration therapy had a higher risk of paralytic ileus, but it also had a shorter hospital stay and lower risk of phlebitis 5.
Antibiotic Treatment
- Antibiotic treatment of gastroenteritis in primary care is relatively infrequent, with 1 in 11 episodes treated 6.
- Empirical treatment was more frequent compared with targeted treatment and mostly with non-recommended antibiotics, but treatment based upon diagnostic faeces testing results followed clinical practice guidelines recommendations 6.
- Non-susceptibility to first- or second-choice antibiotics was demonstrated in some Salmonella and Campylobacter isolates, highlighting the importance of antibiotic stewardship 6.