Dysenteric Diarrhea (other than C. difficile)

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration

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

Patient may be febrile and toxic





E. coli 0157:H7

Azithromycin OR Ciprofloxacin

(avoid antibiotic treatment in cases of E. coli O157:H7 as it may increase the risk of hemolytic-uremic syndrome)

Most outpatients do not warrant empiric antibiotics.

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

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.
3 days

Clinical Infectious Diseases, Volume 65, Issue 12, 29 November 2017, Pages e45–e80, https://doi.org/10.1093/cid/cix669