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Selected Oral Antibiotics for Infectious Gastroenteritis*

Organism

Antibiotic

Campylobacter jejuni

AzithromycinAzithromycin

CiprofloxacinCiprofloxacin †

Cholera (Vibrio cholerae)

CiprofloxacinCiprofloxacin

Doxycycline §Doxycycline §

AzithromycinAzithromycin

Clostridioides difficile

Vancomycin Vancomycin

FidaxomicinFidaxomicin

MetronidazoleMetronidazole ‖

Entamoeba histolytica

MetronidazoleMetronidazole ¶

TinidazoleTinidazole ¶

Giardia intestinalis (G. lamblia)

TinidazoleTinidazole

MetronidazoleMetronidazole

NitazoxanideNitazoxanide

Shigella

CiprofloxacinCiprofloxacin

AzithromycinAzithromycin

* Antibiotics are not indicated in most cases but may be used supportively with IV fluids to treat infections caused by specific organisms.

† Resistance is increasing.

‡ Antibiotic selection should be guided by susceptibility testing when available because resistance to doxycycline, fluoroquinolones, and sulfamethoxazole/trimethoprim (SMX/TMP) is increasing in certain areas and strains. In general, ‡ Antibiotic selection should be guided by susceptibility testing when available because resistance to doxycycline, fluoroquinolones, and sulfamethoxazole/trimethoprim (SMX/TMP) is increasing in certain areas and strains. In general,doxycycline is the recommended first-line antibiotic for non-pregnant adults. Azithromycin is first-line for children and pregnant women and 2nd-line for others. Other recommendations vary, but SMX/TMP is generally a 2nd-line antibiotic for children if the strain in an outbreak is susceptible. Ciprofloxacin is 2nd- or 3rd-line in non-pregnant adults and, although generally avoided in children, can be used as 2nd line if strains are resistant to SMX/TMP.is the recommended first-line antibiotic for non-pregnant adults. Azithromycin is first-line for children and pregnant women and 2nd-line for others. Other recommendations vary, but SMX/TMP is generally a 2nd-line antibiotic for children if the strain in an outbreak is susceptible. Ciprofloxacin is 2nd- or 3rd-line in non-pregnant adults and, although generally avoided in children, can be used as 2nd line if strains are resistant to SMX/TMP.

§ This antibiotic should not be given to pregnant women.

Metronidazole is not recommended but may be used in patients intolerant of vancomycin and fidaxomicin.‖ Metronidazole is not recommended but may be used in patients intolerant of vancomycin and fidaxomicin.

¶ Treatment should be followed by a course of iodoquinol for 20 days or paromomycin for 7 days.¶ Treatment should be followed by a course of iodoquinol for 20 days or paromomycin for 7 days.