Sandbox/diarrhea

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Pathogen Specific

▸ Click on the following categories to expand treatment regimens.[1][2]

Shigella species

  ▸  Adults

  ▸  Children

Non-typhi species of Salmonella

  ▸  Adults

  ▸  Children

Campylobacter species

  ▸  Adults

  ▸  Children

Enterotoxigenic E.coli species

  ▸  Adults

  ▸  Children

Enteropathogenic E.coli species

  ▸  Adults

  ▸  Children

Enteroinvasive E.coli species

  ▸  Adults

  ▸  Children

Enteroaggregative E.coli species

  ▸  Adults

  ▸  Children

Enterohemorrhagic E.coli species

  ▸  Adults

  ▸  Children

Aeromonas / Plesiomonas

  ▸  Adults

  ▸  Children

Yersinia species

  ▸  Adults

  ▸  Children

Vibrio cholerae O1 or O139

  ▸  Adults

  ▸  Children

Toxigenic Clostridium difficile

  ▸  Adults

  ▸  Children

Giardia species

  ▸  Adults

  ▸  Children

Cryptosporidium species

  ▸  Adults

  ▸  Children

Isospora species

  ▸  Adults

  ▸  Children

Cyclospora species

  ▸  Adults

  ▸  Children

Microsporidium species

  ▸  Adults

  ▸  Children

Entamoeba histolytica

  ▸  Adults

  ▸  Children

Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 3 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 3 days
OR
Norfloxacin 400 mg orally q12h X 3 days
OR
Ciprofloxacin 500 mg orally q12h X 3 days
OR
Nalidixic acid 1g orally q24h X 5 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 3 days
OR
Azithromycin X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 7-10 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 7-10 days
OR
Norfloxacin 400 mg orally q12h X 7-10 days
OR
Ciprofloxacin 500 mg orally q12h X 7-10 days
OR
Nalidixic acid 1g orally q24h X 7-10 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 7-10 days
OR
Azithromycin X 7-10 days
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 3 days
Alternative Regimen
Nalidixic acid 55 mg/kg/day X 5 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 3 days
OR
Azithromycin X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 7-10 days
Alternative Regimen
Nalidixic acid 55 mg/kg/day X 7-10 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 7-10 days
OR
Azithromycin X 7-10 days
Immunocompetent
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 5-7 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 14 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 14 days
OR
Norfloxacin 400 mg orally q12h X 14 days
OR
Ciprofloxacin 500 mg orally q12h X 14 days
OR
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 14 days
Immunocompetent
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 5-7 days
Alternative Regimen
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 5-7 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 14 days
Alternative Regimen
Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 14 days
Immunocompetent
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised
Erythromycin 500 mg orally q12h X extended period
Immunocompetent
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised
Erythromycin 500 mg orally q12h X extended period
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 3 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 3 days
OR
Norfloxacin 400 mg orally q12h X 3 days
OR
Ciprofloxacin 500 mg orally q12h X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days


Immunocompetent patients
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Erythromycin 500 mg orally q12h X 5 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Unknown
Immunocompromised patients
Preferred Regimen (For ETEC)
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Unknown
Immunocompromised patients
Preferred Regimen
Unknown
Immunocompetent patients
Preferred Regimen
Role of antibiotics unclear, and administration should be avoided
Immunocompromised patients
Preferred Regimen
Role of antibiotics unclear, and administration should be avoided
Immunocompetent patients
Preferred Regimen
Role of antibiotics unclear, and administration should be avoided
Immunocompromised patients
Preferred Regimen
Role of antibiotics unclear, and administration should be avoided
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 3 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 3 days
OR
Norfloxacin 400 mg orally q12h X 3 days
OR
Ciprofloxacin 500 mg orally q12h X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
Alternative Regimen
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 3 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen (Only for severe infections or bacteremia)
Doxycycline 300 mg orally single dose
OR
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
OR
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
OR
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen (Only for severe infections or bacteremia)
Doxycycline 300 mg orally single dose
OR
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Doxycycline 300 mg orally single dose
OR
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 3 days
OR
Ofloxacin 300 mg orally q12h X 3 days
OR
Norfloxacin 400 mg orally q12h X 3 days
OR
Ciprofloxacin 500 mg orally q12h X 3 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
OR
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Doxycycline 300 mg orally single dose
OR
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Metronidazole 250 mg orally q6h X 10 days
OR
Metronidazole 500 mg orally q8h X 10 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
OR
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Metronidazole 250 mg orally q6h X 10 days
OR
Metronidazole 500 mg orally q8h X 10 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Metronidazole 250-750 mg orally q8h X 7-10 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days
OR
Ofloxacin 300 mg orally q12h X 5-7 days
OR
Norfloxacin 400 mg orally q12h X 5-7 days
OR
Ciprofloxacin 500 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen
Metronidazole 250-750 mg orally q8h X 7-10 days
Immunocompromised patients
Preferred Regimen
Doxycycline 300 mg orally single dose
PLUS
Tetracycline 500 mg orally q6h X 3 days
Alternative Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 5-7 days
Immunocompetent patients
Preferred Regimen (only if severe)
Paromomycin 500 mg orally q8h X 7 days
Immunocompromised patients
Preferred Regimen
Paromomycin 500 mg orally q8h X 14-28 days
THEN
Paromomycin 500 mg orally q12h X if needed
Immunocompetent patients
Preferred Regimen (only if severe)
Paromomycin 500 mg orally q8h X 7 days
Immunocompromised patients
Preferred Regimen
Paromomycin 500 mg orally q8h X 14-28 days
THEN
Paromomycin 500 mg orally q12h X if needed
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 7-10 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q6h X 10 days
THEN
Trimethoprim-sulfamethoxazole 160/800 mg orally thrice weekly indefinitely
Alternative Regimen (indefinitely for AIDS patients)
Sulfadoxine 500 mg
PLUS
Pyrimethamine 25 mg
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 7-10 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q6h X 10 days
THEN
Trimethoprim-sulfamethoxazole 5/25 mg orally thrice weekly indefinitely
Alternative Regimen (indefinitely for AIDS patients)
Sulfadoxine 500 mg
PLUS
Pyrimethamine 25 mg
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 7 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 160/800 mg orally q6h X 10 days
THEN
Trimethoprim-sulfamethoxazole 160/800 mg orally thrice weekly indefinitely
Immunocompetent patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q12h X 7 days
Immunocompromised patients
Preferred Regimen
Trimethoprim-sulfamethoxazole 5/25 mg orally q6h X 10 days
THEN
Trimethoprim-sulfamethoxazole 5/25 mg orally thrice weekly indefinitely
Immunocompetent patients
Preferred Regimen
Not determined
Immunocompromised patients
Preferred Regimen
Albendazole 400 mg orally q12h X 21 days
Immunocompetent patients
Preferred Regimen
Not determined
Immunocompromised patients
Preferred Regimen
Albendazole 400 mg orally q12h X 21 days
Immunocompetent patients
Preferred Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Diiodohydroxyquin 650 mg orally q8h X 20 days
Alternative Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Paromomycin 500 mg orally q8h X 7 days
Immunocompromised patients
Preferred Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Diiodohydroxyquin 650 mg orally q8h X 20 days
Alternative Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Paromomycin 500 mg orally q8h X 7 days
Immunocompetent patients
Preferred Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Diiodohydroxyquin 650 mg orally q8h X 20 days
Alternative Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Paromomycin 500 mg orally q8h X 7 days
Immunocompromised patients
Preferred Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Diiodohydroxyquin 650 mg orally q8h X 20 days
Alternative Regimen
Metronidazole 750 mg orally q8h X 5-10 days
PLUS
Paromomycin 500 mg orally q8h X 7 days

References

  1. Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
  2. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC; et al. (2010). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)". Infect Control Hosp Epidemiol. 31 (5): 431–55. doi:10.1086/651706. PMID 20307191.