From the Guidelines
Antibiotics should only be prescribed for bacterial gastroenteritis in specific cases, such as Shigella, Campylobacter, or severe Salmonella infections, as most infections resolve within 3-5 days without specific treatment and unnecessary antibiotics can worsen symptoms by disrupting gut flora. The recommended treatment for bacterial gastroenteritis primarily involves supportive care with fluid and electrolyte replacement to prevent dehydration. Oral rehydration solutions like Pedialyte or homemade solutions (1 liter of water with 6 teaspoons of sugar and 1/2 teaspoon of salt) should be consumed regularly in small amounts. In severe cases, intravenous fluids may be necessary.
Some key points to consider when treating bacterial gastroenteritis include:
- Antibiotics may be prescribed for specific bacterial infections, such as:
- Shigella: azithromycin 500mg once daily for 3 days 1
- Campylobacter: azithromycin 500mg once daily for 3 days 1
- Severe Salmonella infections: ceftriaxone or ciprofloxacin 1
- Anti-diarrheal medications such as loperamide (Imodium) should be avoided with high fever or bloody diarrhea as they can prolong the infection.
- A bland diet (BRAT - bananas, rice, applesauce, toast) can help manage symptoms while recovering.
- Probiotics like Lactobacillus or Saccharomyces boulardii may help restore normal gut flora and shorten illness duration 1.
- Proper handwashing and food safety practices are essential to prevent spread to others.
It's essential to note that the use of antibiotics should be guided by the severity of the infection, the presence of specific bacterial pathogens, and the patient's overall health status. The choice of antibiotic should be based on local resistance patterns and the specific pathogen involved 1.
From the FDA Drug Label
Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. Vancomycin Hydrochloride Capsules are also used for the treatment of enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) in adult and pediatric patients less than 18 years of age
Antibiotics for bacterial gastroenteritis are recommended when the cause is proven or strongly suspected to be caused by susceptible bacteria, such as:
- C. difficile-associated diarrhea
- Staphylococcal enterocolitis The recommended treatment is Vancomycin Hydrochloride Capsules orally, with dosages varying depending on the patient's age and condition 2.
From the Research
Treatment of Bacterial Gastroenteritis
- The recommended treatment for bacterial gastroenteritis depends on the etiology and severity of the disease 3, 4.
- Antibiotic therapy is not required in most patients with acute gastroenteritis, as the illness is usually self-limiting 4.
- However, empirical antimicrobial therapy may be necessary in certain situations, such as:
- The choice of antimicrobial agent should be made on a clinical basis, before culture results are available 3.
- Good antibiotic stewardship is a key strategy to decrease rates of antibiotic-resistant infections, such as Clostridioides difficile infection 5, 6.
Specific Treatment Guidelines
- For an initial episode of non-severe C. difficile infection, oral vancomycin or oral fidaxomicin is recommended 5.
- Metronidazole is no longer recommended as first-line therapy for adults with C. difficile infection 5.
- Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes 5.
Prevention and Control
- Preventing dehydration or providing appropriate rehydration is the primary supportive treatment of acute gastroenteritis 6.
- Contact precautions, public health education, and prudent use of antibiotics are necessary goals in decreasing the prevalence of Clostridium difficile 6.
- Guidelines for antibiotic use in acute gastroenteritis have been developed to decrease antibiotic misuse and prevent antibiotic resistance 7.