From the Guidelines
Antibiotics are not generally recommended for acute diarrhea in adults without fever, dehydration, or travel history, except in cases of suspected bacterial infection, such as dysentery or severe diarrhea.
Indications for Antibiotics
- Dysentery: Azithromycin is the first-line agent for dysentery, due to its efficacy against Shigella spp. and other bacterial causes 1.
- Severe diarrhea: Antibiotics may be considered for severe diarrhea, particularly if bacterial infection is suspected, such as campylobacteriosis or infections due to Shigella spp. 1.
Choice of Antibiotic
- Azithromycin: Azithromycin is a recommended first-line agent for dysentery and severe diarrhea, due to its efficacy and safety profile 1.
- Fluoroquinolones: Fluoroquinolones, such as ciprofloxacin, may be considered as an alternative, but their use is limited by concerns about resistance and potential side effects 1.
Important Considerations
- Resistance patterns: The choice of antibiotic should take into account regional patterns of antimicrobial resistance 1.
- Side effects: The potential side effects of antibiotics, such as gastrointestinal complaints and central nervous system effects, should be considered 1.
- Alternative treatments: Non-antimicrobial treatments, such as oral rehydration solutions and probiotic agents, may be considered as an alternative to antibiotics 1.
From the Research
Indications for Antibiotics in Acute Diarrhea
The following are indications for antibiotics in acute diarrhea, excluding age > 75 years, fever, dehydration, or travel history:
- Severe comorbidities 2
- Immunodeficiency 2, 3
- Shigella infection 2, 4
- Clostridium difficile infection 2, 4
- Inflammatory diarrhea 5
- Bloody diarrhea, in certain cases 4, 5
- Recent hospitalization 5
- Immunocompromise 5
Diagnostic Considerations
Diagnostic investigation should be reserved for patients with:
- Severe illness 4
- Persistent fever 4, 3
- Bloody stool 4, 5
- Immunocompromise 4, 5
- Suspected nosocomial infection or outbreak 4
Treatment
Antibiotics are effective in the treatment of: