What antibiotics are used to treat enteritis?

Antibiotics for Enteritis

For infectious enteritis, empiric antibiotic therapy should be guided by the suspected pathogen, with azithromycin being the first choice for Campylobacter, ciprofloxacin or azithromycin for Shigella, and targeted therapy only for specific indications in Salmonella infections. 1

Pathogen-Specific Antibiotic Recommendations

Campylobacter

• First choice: Azithromycin 1
• Alternative: Ciprofloxacin 1

Shigella

• First choice: Azithromycin or ciprofloxacin 1
• Alternative: Ceftriaxone 1
• Note: Avoid fluoroquinolones if ciprofloxacin MIC is ≥0.12 μg/mL even if reported as susceptible 1

Nontyphoidal Salmonella

• Usually not indicated for uncomplicated infection 1
• Consider antibiotics only for high-risk groups: neonates (up to 3 months), persons >50 years with suspected atherosclerosis, immunosuppressed individuals, those with cardiac disease or significant joint disease 1
• If treatment indicated and organism is susceptible: ceftriaxone, ciprofloxacin, TMP-SMX, or amoxicillin 1

Salmonella Typhi or Paratyphi

• First choice: Ceftriaxone or ciprofloxacin 1
• Alternatives: Ampicillin, TMP-SMX, or azithromycin 1

Clostridium difficile

• First choice: Oral vancomycin 1
• Alternative: Fidaxomicin (not recommended for people <18 years) 1
• Metronidazole acceptable for nonsevere CDI in children and as second-line for adults with nonsevere CDI 1

When to Use Antibiotics for Enteritis

• Antibiotic treatment should be considered when there is evidence of systemic symptoms or worsening clinical condition 1
• The decision to initiate antibiotic therapy should be made on clinical grounds before culture results are available 2, 3
• Empiric therapy is appropriate when clinical or epidemiologic features suggest a treatable bacterial origin or a high-risk host 4
• The presence of leukocytes or blood in stool supports the decision for empiric therapy 4

Special Populations

Pediatric Patients

• Selection of antimicrobial therapy should be based on infection origin (community vs. healthcare), illness severity, and safety of agents in specific pediatric age groups 1
• For children with severe reactions to β-lactams, ciprofloxacin plus metronidazole or an aminoglycoside-based regimen are recommended 1

Neonates with Necrotizing Enterocolitis

• Broad-spectrum antibiotics recommended: ampicillin, gentamicin, and metronidazole; or ampicillin, cefotaxime, and metronidazole; or meropenem 1
• Vancomycin may replace ampicillin for suspected MRSA or ampicillin-resistant enterococcal infection 1
• Antifungal therapy (fluconazole or amphotericin B) should be added if fungal infection is suspected 1

Common Pitfalls to Avoid

• Unnecessary antibiotic use for uncomplicated Salmonella enteritis in immunocompetent hosts - studies show no benefit of antibiotics in these cases 5, 6
• Using antibiotics for STEC infections, which is generally not recommended and may increase risk of hemolytic uremic syndrome 6
• Failing to consider local antimicrobial resistance patterns, particularly increasing resistance of E. coli to fluoroquinolones 1
• Not adjusting therapy when culture and susceptibility reports become available 1
• Overlooking the need for antifungal therapy in immunocompromised patients or neonates when Candida is isolated 1

Monitoring and Duration

• Broad-spectrum antimicrobial therapy should be tailored when culture and susceptibility reports become available 1
• If clinical symptoms worsen on antibiotics, consider antibiotic-associated diarrhea, C. difficile infection (particularly with fever or leukocytosis >20,000 cells/μL), or antimicrobial resistance 1
• For most uncomplicated cases, 5-7 days of therapy is sufficient, though duration should be based on clinical response 4, 5