From the Guidelines
Treatment for bacterial gastroenteritis primarily involves supportive care with fluid and electrolyte replacement, while antibiotics are reserved for specific situations, such as severe cases, immunocompromised patients, or specific pathogens like Shigella or Campylobacter, where azithromycin is recommended as the first-line agent due to its efficacy and safety profile 1.
Supportive Care
Most cases can be managed at home with oral rehydration solutions like Pedialyte or a homemade mixture of 1 teaspoon salt, 8 teaspoons sugar, and 1 liter of clean water. Patients should drink small amounts frequently to prevent dehydration. A bland diet (BRAT - bananas, rice, applesauce, toast) can be followed as tolerated, gradually returning to normal eating.
Antibiotic Use
Antibiotics are generally not recommended for uncomplicated cases as they may prolong bacterial shedding and contribute to antibiotic resistance. However, according to the 2017 Infectious Diseases Society of America clinical practice guidelines, empiric antimicrobial therapy is recommended for certain situations, such as infants <3 months of age with suspicion of a bacterial etiology, ill immunocompetent people with fever, abdominal pain, bloody diarrhea, and bacillary dysentery, and people who have recently travelled internationally with body temperatures ≥38.5°C and/or signs of sepsis 1.
Choice of Antibiotic
The choice of antibiotic should be based on the severity of illness, local susceptibility patterns, and travel history. Azithromycin is recommended as the first-line agent for dysentery and acute watery diarrhea with greater than mild fever due to its efficacy and safety profile, as well as its effectiveness against FQ-resistant Campylobacter and other bacterial causes 1. Ciprofloxacin may also be used, but its efficacy may be reduced in areas with high rates of FQ-resistant Campylobacter.
Prevention
Prevention through proper handwashing, safe food handling, and avoiding contaminated water sources is essential to prevent spread and recurrence of bacterial gastroenteritis.
- Key points to consider:
- Azithromycin is the recommended first-line agent for dysentery and acute watery diarrhea with greater than mild fever.
- Ciprofloxacin may be used as an alternative, but its efficacy may be reduced in areas with high rates of FQ-resistant Campylobacter.
- Antibiotics should be reserved for specific situations, such as severe cases, immunocompromised patients, or specific pathogens.
- Supportive care with fluid and electrolyte replacement is essential for managing bacterial gastroenteritis.
- Prevention through proper handwashing, safe food handling, and avoiding contaminated water sources is crucial to prevent spread and recurrence of the disease.
From the Research
Treatment Overview
- The treatment for bacterial gastroenteritis typically involves antibiotic therapy, but it is only recommended for specific bacterial causes, such as Shigella, Vibrio cholerae, Campylobacter, and severe cases of Salmonella infection 2, 3, 4.
- The choice of antibiotic depends on the suspected causative agent, host conditions, and local epidemiology 4, 5.
- Azithromycin is the preferred antibiotic for infections due to Shigella and Campylobacter, while ceftriaxone and ciprofloxacin are recommended for salmonellosis when antibiotic treatment is indicated 2.
Antibiotic Therapy
- Antibiotic treatment is important for clinical improvement and eradication of the causative organism from stools, which is important epidemiologically 3.
- Empiric therapy may be started while awaiting the results of microbiological investigations, and the choice of antibiotic depends on suspected agents, host conditions, and local epidemiology 5.
- In most cases, empiric therapy should be started with oral co-trimoxazole or metronidazole, but in severe cases, parenteral treatment with ceftriaxone or ciprofloxacin might be considered 5.
Non-Antibiotic Treatment
- Oral rehydration solution is the mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis 6.
- Antiemetics may be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 6.
- Rehydration is the key treatment, and symptoms generally resolve without specific therapy 5.