title: Antimicrobial therapy of acute diarrhoea: a clinical review.
abstract: Diarrhoea is one of the most commonly occurring diseases. This article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. The general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and Campylobacter infections, as well as infections with pathogenic Escherichia coli strains, yersiniosis and cholera. Diarrhoea caused by toxigenic Clostridium difficile strains has increased in incidence and in severity. These infections will therefore be described in detail, including important new aspects of treatment. Symptomatic therapy is still the most important component of the treatment of infectious diarrhoea. However, empirical antibiotic therapy should be considered for severely ill patients with a high frequency of stools, fever, bloody diarrhoea, underlying immune deficiency, advanced age or significant comorbidities. Increasing resistance, in particular against fluoroquinolones, must be taken into consideration. Therapy with motility inhibitors is not recommended for Shiga toxin-producing Escherichia coli (STEC) infections, Clostridium difficile infections (CDI), and severe colitis. The macrocyclic antibiotic fidaxomicin can reduce the rate of recurrent disease in CDI. Furthermore, evidence for the benefits of faecal microbiota transplantation as a treatment option for multiple recurrences of CDI is increasing. In conclusion, the treatment of acute diarrhoea is still primarily supportive. General empirical antibiotic therapy for acute diarrhoea is not evidence-based.
authors.affiliation: a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lübbert
mesh_terms: D000208:Acute Disease; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D002169:Campylobacter Infections / Q000175:diagnosis / Q000188:drug therapy; D002771:Cholera / Q000175:diagnosis / Q000188:drug therapy; D002939:Ciprofloxacin / Q000627:therapeutic use; D003967:Diarrhea / Q000188:drug therapy*; D064806:Dysbiosis / Q000139:chemically induced; D004405:Dysentery, Bacillary / Q000175:diagnosis / Q000188:drug therapy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy; D000077732:Fidaxomicin; D005759:Gastroenteritis / Q000188:drug therapy*; D006801:Humans; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D012480:Salmonella Infections / Q000175:diagnosis / Q000188:drug therapy; D054323:Shiga-Toxigenic Escherichia coli; D015009:Yersinia Infections / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D012294:Rifamycins; D002939:Ciprofloxacin; D017963:Azithromycin; D000078262:Rifaximin; D000077732:Fidaxomicin
keywords: Antimicrobial therapy; Clostridium difficile; GI tract; colonisation; diarrhoea; gastroenteritis; infection; resistance