Campylobacter | Diarrhea, abdominal pain, fever, malaise Often hematochezia in infants | Typically self limited; 20% have relapse or prolonged symptoms Treat if: moderate-severe symptoms, relapse, immunocompromised, day care and institutions Options: erythromycin, azithromycin, ciprofloxacin |
Escherichia coli–Shiga toxin producing | Bloody or nonbloody diarrhea, severe abdominal pain | None indicated; debated risk of increased incidence of hemolytic uremic syndrome with treatment |
E coli–enteropathogenic | Severe watery diarrhea | Options: trimethoprim-sulfamethoxazole, azithromycin, ciprofloxacin |
E coli–enterotoxigenic | Moderate watery diarrhea, abdominal cramps | Treat if severe symptoms Options: trimethoprim-sulfamethoxazole, azithromycin, ciprofloxacin |
E coli–enteroinvasive | Fever, bloody or nonbloody dysentery | Treat if dysentery Options: trimethoprim-sulfamethoxazole, azithromycin, ciprofloxacin |
E coli–enteroaggregative | Watery, occasionally bloody diarrhea | Options: trimethoprim-sulfamethoxazole, azithromycin, ciprofloxacin |
Salmonella | Mild: watery diarrhea, mild fever, abdominal cramps Typhoid fever: high fever, constitutional symptoms, abdominal pain, hepatosplenomegaly, rose spots, altered mental status | Typically self limited Treat if: < 3 mo of age, hemoglobinopathy, immunodeficiency, chronic GI tract disease, malignancy, severe colitis, bacteremia, sepsis Gastroenteritis: ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, cefotaxime, ceftriaxone, fluoroquinolone Invasive disease: cefotaxime, ceftriaxone |
Shigella | Mild: watery stools without constitutional symptoms Severe: fever, abdominal pain, tenesmus, mucoid stools, hematochezia | Typically self limited (48 to 72 h) Treat if: immunocompromised, severe disease, dysentery or systemic symptoms Options: azithromycin, trimethoprim-sulfamethoxazole, ceftriaxone, ciprofloxacin |
Yersinia | Bloody diarrhea with mucus, fever, abdominal pain Pseudoappendicitis syndrome: fever, right lower quadrant pain, leukocytosis | Typically self limited Treat if: sepsis, non-GI infections, immunocompromised, excess iron storage condition (desferrioxamine use, sickle cell anemia, thalassemia) Options: trimethoprim-sulfamethoxazole, aminoglycosides, cefotaxime, fluoroquinolones, tetracycline, doxycycline |