Antimicrobial Therapy

1. Salmonella. Antibiotic treatment is associated with prolonged excretion of the organism and does not appear to change the natural course of the disease. Antibiotics are indicated only for ill-appearing children, patients at risk of Salmonella bacteremia (including young infants and immunocompromised patients), and secondary infections (eg, osteomyelitis, meningitis).

Antibiotic sensitivity is crucial because resistance is common. Treatment is ampicillin, trimethoprim-sulfamethoxazole (TMP-SMX), or a third-generation cephalosporin.

2. Shigella. Antibiotics are recommended to decrease duration of illness and fecal shedding. Antibiotic sensitivity is crucial because resistance is common. Treatment is TMP-SMX or ciprofloxacin.

3. Campylobacter. Most cases are self-limited and do not require antibiotic therapy. More severe cases can be treated with erythromycin or ciprofloxacin.Treatment generally improves clinical course of disease.

4. Yersinia. Most cases are self-limited. Antibiotics are of questionable value because no clear relationship exists between antibiotic administration and clinical improvement.

5. E coli. Most illnesses caused by these organisms are acute and self-limited and do not require antibiotic therapy.

6. C difficile. Often associated with previous or ongoing antibiotic treatment; therefore, discontinue offending antibiotic. Documented enterocolitis is treated with oral or IV metronidazole or oral vancomycin.

7. G lamblia. Metronidazole is drug of choice for treating symptomatic giardiasis. Furazolidone is an alternative that is supplied in a liquid form.

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