Severe

• > 6 diarrheal episodes/day
• bloody diarrhea
• persistent (> 1 week) diarrhea
• +/- fever

- Culture recommended.

- Tailor antibiotics to C&S results. See Severe, Culture-directed for recommendations.

- Empiric therapy not generally recommended unless patient is immunocompromised, or had recent international travel with fever. 

NB: Antibiotic therapy contraindicated if clinical suspicion of hemolytic uremic syndrome (HUS) as it may enhance toxin release and increase risk of HUS. Clinical signs of HUS/TTP:

• diarrhea that becomes bloody after 1-4 days
• elevated serum creatinine/oliguria/anuria
• thrombocytopenia (platelets <15 x 10⁹/L)
• microangiopathic hemolytic anemia (Hgb < 100g/L).

Alternative