What is the typical treatment duration for an otherwise healthy adult with bacterial enteritis?

Bacterial Enteritis Treatment Duration

For otherwise healthy adults with bacterial enteritis, empiric antibiotic therapy is generally not recommended, and when treatment is indicated, a 5-7 day course is appropriate for most cases. 1, 2

When Antibiotics Are NOT Recommended

• Most cases of acute watery diarrhea in otherwise healthy adults without recent international travel should not receive empiric antimicrobial therapy. 1
• Uncomplicated Salmonella gastroenteritis in healthy hosts should not be treated with antibiotics, as treatment does not shorten illness duration and may prolong the carrier state. 1
• STEC (Shiga toxin-producing E. coli) infections, including O157 and non-O157 strains producing Shiga toxin 2, should never be treated with fluoroquinolones, β-lactams, TMP-SMX, metronidazole, or macrolides due to evidence of harm (increased risk of hemolytic uremic syndrome). 1

When Antibiotics ARE Indicated

Empiric treatment should be considered in:

• Patients with severe inflammatory diarrhea (bloody stools, high fever, systemic toxicity) who present early in their illness course (within 48 hours of symptom onset). 3
• Immunocompromised patients or those with significant underlying health conditions. 1, 3
• Confirmed shigellosis or traveler's diarrhea. 1, 3

Treatment Duration by Pathogen

Campylobacter Enteritis

• Duration: 5-7 days when treatment is indicated. 2
• Treatment benefit is modest and primarily seen when initiated within 48 hours of symptom onset. 1
• Fluoroquinolone resistance is increasing, limiting empiric use. 1, 3

Salmonella Enteritis (Non-Typhoidal)

• No treatment recommended for uncomplicated cases in healthy adults. 1
• Duration: 5-7 days if treatment is necessary due to severe illness or high-risk host factors. 2
• Antibiotics do not eradicate the organism and may prolong carriage. 3

Shigellosis

• Duration: 5-7 days with fluoroquinolones as first-line therapy. 2, 3
• Treatment significantly reduces symptom duration and severity. 3

Typhoid Fever

• Duration: 10 days with ciprofloxacin 500 mg every 12 hours. 2

Antibiotic Selection

First-line empiric therapy (when indicated):

• Ciprofloxacin 500 mg orally every 12 hours for 5-7 days is the preferred empiric choice for infectious diarrhea. 2
• Check local fluoroquinolone resistance patterns before prescribing, as E. coli resistance is increasing. 4

Alternative for severe cases or fluoroquinolone resistance:

• Azithromycin may be considered, though data for enteritis are limited compared to traveler's diarrhea. 1

Critical Timing Considerations

• Treatment must be initiated within 48 hours of symptom onset to achieve meaningful clinical benefit in bacterial enteritis. 3
• Delayed treatment (>48 hours after onset) shows minimal to no clinical benefit even with appropriate antibiotics. 3
• The severity of illness at presentation is more important than the specific pathogen in determining need for treatment. 3

Common Pitfalls to Avoid

• Do not treat bloody diarrhea empirically without considering STEC infection, especially in the absence of fever, as antibiotics can precipitate hemolytic uremic syndrome. 1
• Do not extend treatment beyond 7 days for uncomplicated bacterial enteritis, as longer courses have not been associated with improved outcomes. 1
• Do not treat asymptomatic contacts of patients with bacterial enteritis. 1
• Avoid empiric treatment in patients presenting >48-72 hours after symptom onset, as the window for therapeutic benefit has likely passed and most cases are self-limited. 3