Bacterial Gastroenteritis

Bacterial gastroenteritis, community-onset 

Characterized by frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping 

Escherichia coli 

Salmonella species 

Shigella species 

Campylobacter jejuni 

Yersinia enterocolitica 

Supportive care is the primary therapy for most patients 

Antibiotics can predispose to complications such as hemolytic uremic syndrome with Shiga-toxin producing E. coli infection 

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Consider empiric therapy in toxic-appearing patients, young infants*, or immunocompromised hosts, or if recent international travel with diarrhea & fever:        

Azithromycin
10  mg/kg/dose (max 500 mg/dose) enterally daily  

OR 

Ceftriaxone*
50 mg/kg/dose (max 1000 mg/dose) IV q24h  

*For infants 1-3 months of age and if needed for infections with other sites involved e.g. Salmonella gastroenteritis with bloodstream infection. For infant <1 month of age refer to Fever Without a Source - Young Infant section for initial empiric therapy 

Avoid empiric treatment if persistent diarrhea has lasted 14 days or more  

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For traveler's diarrhea (enterotoxigenic E. coli): 

Azithromycin 10 mg/kg/dose (max 500 mg/dose) enterally daily x 3 days - provide un-reconstituted powder for suspension to infants and children traveling in high-risk areas 

Send stool culture (BCH OAK) or bacterial panel (BCH SF) for diagnosis 

Consider testing for Clostridioides difficile if patient has recent hospital or antibiotic exposure 

Blood cultures should also be sent for patients who are hospitalized and/or toxic-appearing  with suspected bacterial gastroenteritis. If antibiotic therapy is given for Salmonella gastroenteritis, blood culture should be obtained prior to initiation of antibiotic.  

Directed therapy may be indicated early in the course for specific pathogens (such as Campylobacter, Shigella, Yersinia) but in most cases should be deferred until a positive stool culture result is obtained. For recommended therapies, refer to IDSA guidelines linked below or consult ID. 

Duration of therapy (if given) depends on the specific diagnosis