Severe, Culture-directed
- > 6 diarrheal episodes/day
- bloody diarrhea
- persistent (> 1 week) diarrhea
- +/- fever
Usual Pathogens
Campylobacter spp
- Symptoms occur 1-10 days after exposure and usually resolve within 2-5 days.
No therapy unless severe, prolonged or immunocompromised.
| Therapy |
Dose |
Duration |
| Azithromycin |
500mg PO daily |
3 days |
Alternative
Shiga toxin-producing E. coli, including E. coli O157:H7
- Avoid antimotility agents.
Antibiotic therapy contraindicated
Salmonella typhi
Salmonella paratyphi
- Relapse rate 10% after antibiotic therapy.
| Therapy |
Dose |
Duration |
| Ciprofloxacin |
500mg PO bid |
7 days |
| or |
|
|
| Azithromycin |
500mg PO daily |
7 days |
No therapy unless high risk
Alternative
Shigella spp
- Advise symptomatic individuals to avoid sexual contact to reduce transmission.
- If bacteremic (rare), use ciprofloxacin, ceftriaxone, or TMP-SMX for 14 days.
| Therapy |
Dose |
Duration |
Base on local susceptibility:
|
|
|
| Azithromycin |
500mg PO daily |
3 days |
Alternative
Vibrio cholerae
- Fluid/rehydration essential.
| Therapy |
Dose |
Duration |
| Doxycycline |
300mg PO once |
1 dose |
| or |
|
|
| Azithromycin |
1g PO once |
1 dose |
Aeromonas spp
Plesiomonas spp
Vibrio spp, not V. cholerae
Yersinia spp
No therapy unless severe, prolonged or immunocompromised
