Empirical antimicrobial
therapy is indicated in patients with diarrhoea who have high
fever and systemic toxicity, dysenteric disease, or travellers' diarrhoea. Antimicrobials are essential for those with severe
shigellosis and
amoebiasis. They are useful or possibly useful for other forms of diarrhoeal disease including
amoebiasis (milder forms),
campylobacteriosis,
cholera,
giardiasis,
shigellosis, and diarrhoea due to a variety of other laboratory-defined bacterial enteropathogens.
Furazolidone is useful in infantile
giardiasis and mildly effective in other forms of bacterial diarrhoea.
Trimethoprim/
sulphamethoxazole is effective against Shigella spp. in ost parts of the world.
Erythromycin is considered the treatment of choice for
campylobacteriosis. For adults, the
quinolone antimicrobials represent the most useful class of drugs for bacterial enteropathogens. Several dilemmas currently exist in the area. They include the lack of drugs for the
therapy of
trimethoprim-resistant
shigellosis in children, overuse of antimicrobials in the developing world, and the potential for post-treatment prolongation of intestinal excretion of non-
typhoid salmonellae. Antimicrobial
chemoprophylaxis can be used in the rare person from an industrialized area during brief travels to a tropical region who has a serious underlying medical problem, cannot exercise care in what is eaten and drunk, and will have the purpose of the trip put at jeopardy should any illness develop (even that rendered short-term by effective
therapy). For most people,
therapy of illness is preferred to prophylaxis.