From the Guidelines
Antibiotics should only be started in select circumstances for gastroenteritis, such as confirmed or highly suspected bacterial gastroenteritis with severe symptoms, in immunocompromised patients, or with specific pathogens like Shigella, Campylobacter, or Vibrio cholerae. The majority of gastroenteritis cases are viral in origin and will resolve without specific treatment.
When considering antibiotic treatment, it's crucial to assess the severity of illness and the impact on the patient's activities and plans. For travelers' diarrhea, antibiotics have been shown to reduce symptom duration, and azithromycin is recommended as the first-line agent for dysentery and acute watery diarrhea with greater than mild fever due to its efficacy against FQ-resistant Campylobacter and other bacterial causes 1.
The choice of antibiotic should be guided by the suspected pathogen, local resistance patterns, and the patient's specific situation. Common antibiotic choices for bacterial gastroenteritis include ciprofloxacin, azithromycin, or trimethoprim-sulfamethoxazole, with the specific choice depending on the suspected pathogen and local resistance patterns 1.
It's essential to obtain stool cultures before starting antibiotics when possible to guide targeted therapy. Overuse of antibiotics can lead to antimicrobial resistance, disrupt gut microbiota, and potentially cause complications like Clostridioides difficile infection, which is why judicious use is essential 1. Regardless of antibiotic use, maintaining hydration remains the cornerstone of gastroenteritis management.
Key considerations for selecting an empiric antibiotic include the likelihood of treatment efficacy, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, and cost 1. The potential for drug interactions and the risk of adverse effects, such as Achilles tendon rupture and C. difficile infection, should also be considered when choosing an antibiotic.
In summary, antibiotic treatment for gastroenteritis should be reserved for severe cases or those with specific indications, and the choice of antibiotic should be guided by the suspected pathogen, local resistance patterns, and the patient's specific situation, with a focus on maintaining hydration and minimizing the risk of adverse effects 1.
From the Research
Indications for Starting Antibiotics in Gastroenteritis
The decision to start antibiotics in gastroenteritis depends on various factors, including the severity of symptoms, the presence of underlying diseases, and the risk of bacteremia.
- The empiric antibiotic therapy for acute gastroenteritis (AGE) is indicated only in patients with underlying diseases or risk for bacteremia 2.
- Patients at high risk due to extremes of age or immunosuppression often require specific therapy to ensure resolution of symptoms 3.
- The indications of empirical antibiotics, and modification of antibiotics after confirming pathogen, are crucial in managing acute gastroenteritis 4.
Specific Patient Groups
- Adults with underlying diseases or risk for bacteremia may benefit from antibiotic therapy 2.
- Immunocompromised patients may require specific therapy to prevent complications 3.
- Patients with severe symptoms, such as bloody stools, fever, or signs of sepsis, may also require antibiotic therapy.
Antibiotic Options
- Azithromycin may be a good empirical therapeutic option for the treatment of bacterial enteritis 5.
- Ciprofloxacin and pivmecillinam have also been shown to be effective in treating acute gastroenteritis 2.
- The susceptibility of enteropathogens to azithromycin and other antibiotics is an important consideration in selecting an antibiotic regimen 6.