Sandbox/diarrhea

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

Antibiotic Therapy

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

Escherichia coli species

  ▸  Enterotoxigenic

  ▸  Enteropathogenic

  ▸  Enteroinvasive

  ▸  Enteroaggregative

  ▸  Enterohemorrhagic (STEC)

Aeromonas / Plesiomonas

  ▸  Adults

  ▸  Children

Yersinia species

  ▸  Adults

  ▸  Children

Vibrio cholerae O1 or O139

  ▸  Adults

  ▸  Children

Toxigenic Clostridium difficile

  ▸  Adults

  ▸  Children

Parasites

  ▸  Giardia

  ▸  Cryptosporidium species

  ▸  Isospora species

  ▸  Cyclospora species

  ▸  Microsporidium species

  ▸  Entamoeba histolytica

Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen (beta-lactam allergy)
Moxifloxacin 400 mg orally q6h AND Clindamycin 300 mg orally q6h
OR
Trimethoprim-sulfamethoxazole 1 double-strength tablet orally q12h AND metronidazole 250 to 500 mg orally q6h
Late (infected)
Preferred Regimen
Ampicillin sulbactam 1.5 gm IV q6h
OR
Cefoxitin 2 gm IV q8h
OR
Ticarcillin clavulanate 3.1 gm IV q6h
OR
Piperacillin-tazobactam 3.375 gm IV q6h or 4.5 gm q8h or 4-hr infusion of 3.375 gm q8h
Alternative Regimen (beta-lactam allergy)
Clindamycin 1.5 gm IV q6h
PLUS
Moxifloxacin 400 mg IV q6h
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate (> 12weeks) 45 mg/kg/day orally in 2 divided doses for 5 days
Late (infected)
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
OR
Amoxicillin-clavulanate 500/125 mg orally q8h
Alternative Regimen (beta-lactam allergy)
Clindamycin 300 mg orally q6h
PLUS
Ciprofloxacin 500 to 750 mg orally q12h
Late (infected)
Preferred Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h
OR
Piperacillin-tazobactam 3.375 gm IV q6-8h
OR
Ertapenem 1 gm IV q24h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Meropenem 1 gm IV q8h
Alternative Regimen (beta-lactam allergy)
Cefazolin 1 gm IV q8h
OR
Cefuroxime 1 gm IV q24h
OR
Cefoxitin 1 gm IV q6-8h
OR
Ceftriaxone sodium 1 gm IV q12h
OR
Cefotaxime 2 gm IV q6h
OR
Ciprofloxacin 400 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen (beta-lactam allergy)
Clindamycin 20 to 30 mg/kg/day orally in 4 divided doses
PLUS
Trimethoprim component 8 mg/kg/day orally in 2 divided doses
Late (infected)
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
OR
Amoxicillin-clavulanate 500/125 mg orally q8h
Alternative Regimen (beta-lactam allergy)
Doxycycline 100 mg orally q12h
OR
Cefuroxime 500 mg orally q12h
Late (infected)
Preferred Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h
OR
Piperacillin-tazobactam 3.375 gm IV q6-8h
OR
Ertapenem 1 gm IV q24h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Meropenem 1 gm IV q8h
Alternative Regimen (beta-lactam allergy)
Cefazolin 1 gm IV q8h
OR
Cefuroxime 1 gm IV q24h
OR
Cefoxitin 1 gm IV q6-8h
OR
Ceftriaxone sodium 1 gm IV q12h
OR
Cefotaxime 2 gm IV q6h
OR
Ciprofloxacin 400 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
Cat scratch disease
Preferred Regimen
Azithromycin 500 mg orally on day 1, then 250 mg orally once daily X 4 days
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen
Cefuroxime 10 to 15 mg/kg orally q12h
Cat scratch disease
Preferred Regimen
Azithromycin 10 mg/kg orally on day 1, then 5 mg/kg orally X 4 days
Late (infected)
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
High risk bites (deep bites, symptomatic animals
Preferred Regimen (without CNS symptoms)
Acyclovir 12.5–15 mg per kg IV q8h
OR
Ganciclovir 5 mg per kg IV q12h
Preferred Regimen (with CNS symptoms)
Ganciclovir 5 mg per kg IV q12h
High risk bites (deep bites, symptomatic animals
Preferred Regimen (without CNS symptoms)
Acyclovir 12.5–15 mg per kg IV q8h
OR
Ganciclovir 5 mg per kg IV q12h
Preferred Regimen (with CNS symptoms)
Ganciclovir 5 mg per kg IV q12h
Uncomplicated
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
Alternative Regimen (beta-lactam allergy)
Doxycycline 100 mg orally q12h
Rat bite fever
Preferred Regimen
Penicillin G benzathine 600,000 to 1,000,000 units/day IM X 10-14 days
OR
Tetracycline 250 to 500 mg orally q6h
Alternative Regimen
Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen
Cefuroxime 10 to 15 mg/kg orally q12h
Rat bite fever
Preferred Regimen
Penicillin G benzathine 25,000 to 50,000 units/day IM X 10-14 days
OR
Tetracycline (>8 years) 25 to 50 mg/kg/day orally in 4 divided doses X 10-14 days
Alternative Regimen
Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days
Pig (Swine)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen
Ampicillin sulbactam
OR
Imipenem
OR
Cephalosporin
Pig (Swine)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen
Ampicillin sulbactam
OR
Imipenem
OR
Cephalosporin
Suspected Leptospirosis
Preferred Regimen
Doxycycline 200 mg orally once within 72 hours of tick removal
Suspected Leptospirosis
Preferred Regimen
Doxycycline (≥8 years) 4 mg/kg (maximum 200 mg) orally once within 72 hours tick removal

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.