From the Guidelines
Azithromycin is the most effective antibiotic for treating gastroenteritis, particularly in cases of dysentery or acute watery diarrhea with high fever, due to its broad-spectrum activity and low resistance rates among common pathogens such as Campylobacter and Shigella species 1.
Key Considerations
- Efficacy: Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1.
- Resistance: The emergence of fluoroquinolone-resistant Campylobacter spp. and other enteric pathogens has led to a strong recommendation for azithromycin as first-line therapy for dysentery and acute watery diarrhea with high fever 1.
- Safety and Tolerance: Azithromycin is generally well tolerated with minimal side effects, although gastrointestinal complaints and central nervous system side effects can occur 1.
- Treatment Regimen: A single 1-gm dose or 500 mg daily for 3 days of azithromycin has been shown to be effective in treating gastroenteritis 1.
Alternative Options
- Fluoroquinolones: Although fluoroquinolones such as ciprofloxacin and levofloxacin are effective against some bacterial pathogens, their use is limited by increasing resistance rates among common pathogens 1.
- Rifaximin: A nonabsorbable antibiotic that is effective against non-invasive diarrhea caused by diarrheagenic E. coli, but less effective against invasive pathogens and not recommended for febrile invasive disease 1.
Special Considerations
- Immunocompromised Hosts: Antimicrobial treatment may be considered in immunocompromised hosts with severe or prolonged disease, although the benefits and risks must be carefully weighed 1.
- STEC Infections: Antibiotic treatment should be avoided in STEC O157 infections and likely non-O157 STEC infections that produce Shiga toxin 2 due to evidence of harm 1.
From the Research
Antibiotic Treatment for Gastroenteritis
The most effective antibiotic for treating gastroenteritis depends on the causative agent of the infection.
- For infections due to Shigella and Campylobacter, Azithromycin is the preferred antibiotic 2.
- For salmonellosis, Ceftriaxone and ciprofloxacin are recommended when antibiotic treatment is indicated 2.
- In cases of acute gastroenteritis where antibiotic therapy is indicated, pivmecillinam and ciprofloxacin have shown similar efficiency 3.
- Fluoroquinolones, such as norfloxacin, pefloxacin, and ofloxacin, are efficient antimicrobial drugs for the treatment of enteric fever, shigellosis, and intestinal salmonellosis 4.
Considerations for Antibiotic Use
- Antibiotic treatment should only be used in cases where it is clinically indicated, as overuse can lead to antibiotic resistance 5, 6.
- The decision to initiate antibiotic therapy and the choice of specific antimicrobial agents should be made on a clinical basis, before culture results are available 5.
- It is essential to reserve antibiotics for the treatment of serious infections to maintain their effectiveness in these conditions 6.