From the Guidelines
The initial approach to acute bacterial diarrhea should involve supportive care with fluid and electrolyte replacement, reserving antibiotics for patients with severe symptoms, immunocompromised status, or specific pathogens like Shigella, Campylobacter, or invasive Salmonella. When antibiotics are indicated, the first-line treatment is typically azithromycin 500 mg once daily for 3 days or ciprofloxacin 500 mg twice daily for 3-5 days, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. For suspected or confirmed Campylobacter, azithromycin is preferred due to increasing fluoroquinolone resistance, as supported by the guidelines for the prevention and treatment of travelers' diarrhea 1. Some key considerations for antibiotic selection include:
- The likelihood of treatment efficacy and rapidity of response
- Regional patterns of probable target pathogens and their antimicrobial resistance
- Safety and tolerance profile of the antibiotic
- Simplicity of treatment regimen and patient adherence
- Cost It's also important to note that asymptomatic contacts of people with bloody diarrhea should not be offered empiric treatment, but should be advised to follow appropriate infection prevention and control measures 1. Additionally, people with clinical features of sepsis who are suspected of having enteric fever should be treated empirically with broad-spectrum antimicrobial therapy after blood, stool, and urine culture collection 1. In terms of specific antibiotic regimens, the following options are recommended:
- Azithromycin 1000 mg by mouth or 500 mg by mouth, single or 1-day divided, 3-day course
- Levofloxacin 500 mg by mouth, single dose or 3-day course
- Ciprofloxacin 750 mg by mouth or 500 mg by mouth, single dose or 3-day course
- Ofloxacin 400 mg by mouth, single dose or 3-day course
- Rifaximin 200 mg by mouth three times daily, 3 days 1. However, it's essential to consider the potential risks and benefits of each antibiotic, including the risk of Clostridium difficile infection, and to choose the most appropriate treatment based on the individual patient's needs and circumstances.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Approach to Acute Bacterial Diarrhea
- The initial approach to acute bacterial diarrhea involves identifying the cause of the infection and assessing the severity of the symptoms 2.
- Antibiotic therapy is considered for certain types of bacterial diarrhea, such as Clostridioides difficile infection (CDI) 3, 4, 5, 6.
Antibiotic Treatment for Acute Bacterial Diarrhea
- For CDI, the antibiotics of choice are vancomycin, fidaxomicin, and metronidazole, although metronidazole is considered inferior 3.
- Fidaxomicin has been shown to be superior to metronidazole and vancomycin for the treatment of initial episode, first recurrence, and non-severe CDI 4, 5.
- Fidaxomicin is also associated with a lower risk of treatment failure and recurrence compared to vancomycin 5.
- The American College of Gastroenterology (ACG) Clinical Guideline recommends an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in adults 2.