What antibiotic is recommended for a 55-year-old male with normal-colored diarrhea and occasional fevers after eating coleslaw?

Antibiotic Treatment for Suspected Foodborne Diarrhea

For a 55-year-old male with normal-colored diarrhea and occasional fevers after eating coleslaw, ciprofloxacin is the recommended first-line antibiotic treatment. 1

Clinical Assessment and Rationale

This presentation suggests a potential foodborne bacterial gastroenteritis:

• History of coleslaw consumption as trigger (common vehicle for bacterial pathogens)
• Fever (suggesting inflammatory/invasive process)
• Normal-colored diarrhea (consistent with many bacterial pathogens)

Likely Pathogens

• Salmonella species
• Campylobacter species
• Shigella species
• Enterotoxigenic E. coli

Antibiotic Selection Algorithm

1. First-line treatment: Ciprofloxacin 500 mg twice daily for 3-7 days 1

   • Fluoroquinolones are recommended as empiric therapy for suspected bacterial diarrhea with fever in adults
   • Ciprofloxacin provides excellent coverage against most common foodborne pathogens

2. Alternative if fluoroquinolone resistance is suspected: Azithromycin 500 mg once daily for 3 days 1, 2

   • Particularly if travel to areas with high fluoroquinolone resistance
   • Better for suspected Campylobacter infections

3. For severe illness or immunocompromised status: Consider IV therapy and hospitalization 1

Important Considerations

• Timing: Start antibiotics promptly given the presence of fever and clear food trigger
• Hydration: Ensure adequate fluid intake to prevent dehydration
• Avoid antidiarrheal agents if high fever or bloody stools develop 1
• Monitor for worsening: Increasing fever, bloody stools, or severe abdominal pain may indicate progression requiring more aggressive management

Potential Pitfalls

1. Antibiotic-associated diarrhea: Antibiotics themselves can cause or worsen diarrhea, particularly through C. difficile infection 3, 4

2. Fluoroquinolone resistance: Increasing worldwide, particularly with Campylobacter species 1, 2

3. STEC infection: Avoid antibiotics if Shiga toxin-producing E. coli is suspected (bloody diarrhea without fever) as antibiotics may increase risk of hemolytic uremic syndrome 1

4. Prolonged carrier state: Antibiotics may prolong Salmonella shedding in some cases 1

Follow-up Recommendations

• If symptoms persist beyond 48-72 hours of antibiotic therapy, consider:
  • Stool culture and sensitivity testing
  • Alternative diagnosis (inflammatory bowel disease, antibiotic-associated colitis)
  • Change in antibiotic therapy based on clinical response

The 2017 Infectious Diseases Society of America guidelines strongly support the use of empiric antibiotics in adults with fever and suspected bacterial diarrhea, with fluoroquinolones being the recommended first-line agents 1.