When to use antibiotics for treating gastroenteritis (inflammation of the stomach and intestines)?

From the Guidelines

Antibiotics should only be used to treat gastroenteritis when there is confirmed bacterial gastroenteritis with moderate to severe symptoms, or in high-risk patients, such as those with laboratory-confirmed infections with bacteria like Shigella, Campylobacter, or Vibrio cholerae, or in cases of traveler's diarrhea with fever and bloody stools. The decision to use antibiotics should be based on the severity of symptoms, the presence of bloody stools, and the patient's overall health status. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, empiric antimicrobial therapy is not recommended for most cases of gastroenteritis, except in specific situations such as severe illness, immunocompromised patients, or laboratory-confirmed bacterial infections.

Some key points to consider when deciding whether to use antibiotics for gastroenteritis include:

• The presence of fever, abdominal pain, or vomiting, which may suggest an infectious cause 1
• The presence of bloody stools, which may indicate a bacterial infection such as Shigella or Campylobacter 1
• The patient's overall health status, including any underlying medical conditions or immunocompromised state 1
• The potential risks and benefits of antibiotic treatment, including the risk of antibiotic resistance and side effects 1

When antibiotics are necessary, common options include:

• Azithromycin (500mg once daily for 3 days) for cases of traveler's diarrhea with fever and bloody stools 1
• Ciprofloxacin (500mg twice daily for 3-5 days) for cases of bacterial gastroenteritis with moderate to severe symptoms 1
• Metronidazole (500mg three times daily for 10-14 days) for cases of Clostridium difficile infection 1

It's essential to note that unnecessary antibiotic use can lead to antibiotic resistance, disrupt gut flora, and cause side effects. Most cases of gastroenteritis should be managed with hydration, rest, and dietary modifications, and patients should seek medical attention if symptoms are severe, persistent, or include high fever, bloody stools, or signs of dehydration.

From the Research

Treatment of Gastroenteritis with Antibiotics

• Gastroenteritis is usually caused by viruses, and antibiotics are not required in most cases 2, 3.
• However, antibiotic treatment may be necessary for certain bacterial causes, such as:
  • Shigella
  • Vibrio cholerae
  • Campylobacter (severe cases)
  • Severe cases of Salmonella infection 2
• The choice of antibiotic depends on the causative agent, with azithromycin preferred for Shigella and Campylobacter, and ceftriaxone and ciprofloxacin recommended for salmonellosis 2.
• Empirical antibiotic treatment without bacteriological documentation should be avoided in most cases 2, 3.
• Antibiotic therapy may be necessary in certain situations, such as:
  • Febrile diarrheal illness
  • Fever and bloody diarrhea
  • Symptoms persisting for >1 week
  • Immunocompromised status 3
• Resistance to antibiotics, such as ceftriaxone, is a concern, and alternative treatments, such as quinolones, may be necessary 4.
• Guidelines for antibiotic use in acute gastroenteritis have been developed to decrease antibiotic misuse and prevent antibiotic resistance 5.
• Studies have shown that empirical treatment with antibiotics, such as ciprofloxacin, can reduce the duration of diarrhea and other symptoms in severe cases of community-acquired gastroenteritis 6.