See site-specific guidelines:

UCSF

ZSFG

VASF

Dysenteric diarrhea (other than C. difficile)

Shigella

Salmonella

Campylobacter

Yersinia

E. coli 0157:H7

Most outpatients do not warrant empiric antibiotics.

Empiric therapy is generally indicated if patient is toxic appearing, elderly or immunocompromised. 

Azithromycin 500mg PO daily x 3 days OR 

Ciprofloxacin

Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.

Patient may be febrile and toxic

Fluoroquinolone resistance may be present, particularly with Shigella and Campylobacter.

Antimicrobial treatment may worsen outcomes in patients with E. coli 0157:H7

Antimotility drugs improve symptoms and can be used if patient is not toxic.  Antimotility drugs should not be used in C.difficile.

Strict handwashing is mandatory in all food preparation.

Viruses

Giardia

Enterotoxigenic E. coli

Enterotoxin-producing bacteria

General Care: Observation

Oral rehydration

Antimotility agents (do not use in C. difficile infection)

Large volume, nonbloody, watery diarrhea.

Patient may have nausea, vomiting, and abdominal cramping but fever often absent

Generally, empiric therapy and stool cultures are not indicated. Most disease is self-limiting and can be treated with antimotility agents.

If patient does not improve, cultures are negative, and symptoms persist, consider stool for parasite PCR

Check C. difficile toxin, especially if recent history of antibiotic use or hospitalization.

Toxigenic E. coli

Salmonella

Shigella

Campylobacter

Mild, self-limited cases can be treated with fluid and electrolyte repletion +/- bismuth subsalicylate.

Azithromycin  OR

Ciprofloxacin OR

EITHER WITH or WITHOUT

Loperamide 4 mg PO x1; then 2 mg after each loose stool,

MAX 16 mg/day