Antibiotic Stewardship in the Patient with Diarrhea: Who Needs Antibiotics? And Which Antibiotics Do I Prescribe?
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.
KeywordsDiarrhea Dehydration Abdominal pain Antibiotics HUS
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