Antibiotic Stewardship in the Patient with Diarrhea: Who Needs Antibiotics? And Which Antibiotics Do I Prescribe?

  • Alexa R. Gale
  • Matthew WilsonEmail author


Most diarrheal illnesses do not benefit from antibiotics, and they should not be prescribed for uncomplicated cases lasting less than 5 days. Bacterial stool cultures are rarely positive. Patients can be advised that not only do empiric antibiotics not benefit most cases of acute diarrhea but they have detrimental short- and long-term effects on the intestinal microbiome. Even when a bacterial source is identified, antibiotics may have limited value. Shiga toxin-producing E. coli (STEC) is associated with hemolytic-uremic syndrome (HUS) after antibiotic treatment of Escherichia coli O157:H7, Shigella, or Campylobacter containing the O157:H7 phage.


Diarrhea Dehydration Abdominal pain Antibiotics HUS 


  1. 1.
    Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32:331–50.CrossRefGoogle Scholar
  2. 2.
    Fletcher SM, McLaws ML, Ellis JT. Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis. J Public Health Res. 2013;2(1):42–53.CrossRefGoogle Scholar
  3. 3.
    Centers for disease control and prevention. Reduction in rotavirus after vaccine introduction – United States, 2000–2009. MMWR Morb Mortal Wkly Rep. 2009;58(41):1146–9.Google Scholar
  4. 4.
    Lübbert C. Antimicrobial therapy of acute diarrhoea: a clinical review. Expert Rev Anti-Infect Ther. 2016;14(2):193–206. Scholar
  5. 5.
    Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 infectious diseases society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):1963–73. Scholar
  6. 6.
    Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000;342(26):1930.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Georgetown University School of Medicine, MedStar Washington Hospital Center, Department of Emergency MedicineWashington, DCUSA

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