Empiric Antibiotic Treatment for Diarrhea

Introduction to Diarrhea Treatment

The Infectious Diseases Society of America recommends that any diarrheal illness lasting more than 1 day, especially 7 days, should prompt evaluation of a fecal specimen before starting empiric antibiotics 1.
The American Gastroenterological Association suggests that fecal testing should include culture, Shiga toxin testing, and consideration of ova and parasites given the prolonged duration 1, 3.

The Centers for Disease Control and Prevention indicate that first-line treatment for empiric antibiotics is Azithromycin 500 mg once daily for 3 days, or single 1-gram dose for severe cases 3.
The World Health Organization recommends that second-line treatment is Fluoroquinolones (ciprofloxacin 500 mg twice daily or levofloxacin 750 mg once daily) only if azithromycin is unavailable and local resistance patterns support use 2, 3.

The American Academy of Pediatrics advises that antibiotics are contraindicated in STEC infections (Shiga toxin-producing E. coli), as they significantly increase the risk of hemolytic uremic syndrome 3.
The European Centre for Disease Prevention and Control suggests that doxycycline should not be used for infectious diarrhea except in the rare circumstance where the patient is simultaneously taking it for malaria prophylaxis during travel 2.

The Infectious Diseases Society of America recommends ordering stool studies immediately: culture, Shiga toxin, ova and parasites 1, 3.
The American Gastroenterological Association advises assessing for high-risk features: fever ≥38.5°C, bloody stools, signs of sepsis, immunocompromised status 3.
The Centers for Disease Control and Prevention indicate that if high-risk features are present, azithromycin 500 mg daily for 3 days should be started while awaiting cultures 3.