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Bacterial Enteritis Treatment and Special Considerations

Organism 

Antibiotic Treatment 

Special Considerations 

E.coli 0157:H7/ 
other Shiga-toxin producing E. coli (STEC) 

Do not treat 
  • Ensure follow-up with PCP within 5 to 7 days of onset of illness to obtain CBC and ask about urine output
  • Hemolytic uremic syndrome (HUS) is a rare but serious sequelae. (See information about HUS)
  • Contact Nephrology with evidence of or additional questions about HUS 

Salmonella sp. 

Do not treat except in patients with risk for invasive disease: 

  • < 3 months of age
  • Chronic GI disease
  • Malignant neoplasms
  • Hemoglobinopathies
  • HIV infection
  • Immunocompromised
  • Severe symptoms (severe diarrhea or prolonged fever)
  • Disseminated infection
  • Septicemia 
 
 

Blood cultures should be considered for patients at risk of severe illness: 

  • < 3 months of age
  • Immunocompromised  
  • Has hemolytic anemia  
  • Evidence of disseminated infection, septicemia, or enteric fever 

Campylobacter sp. 

Useful to treat for: 

  • Symptoms > 1 week
  • Bloody stools
  • Worsening symptoms
  • High fever
  • Immunocompromised 

Immunoreactive complications, such as Guillain-Barré syndrome, reactive arthritis, myocarditis, pericarditis, and erythema nodosum, can occur during convalescence. 

Shigella sp. 

Most useful to treat for: 

  • Severe symptoms (severe diarrhea or prolonged fever)
  • Immunocompromised
  • Patients attending daycare 
  • Empiric therapy may need modification as resistance can be common. Consider discussion with ID if questions.
  • Febrile seizure may occur in patients with Shigella infection 

Yersinia sp. 

Useful to treat for: 

  • Neonates
  • Immunocompromised
  • Septicemia or extraintestinal disease 
 
 
 
 

 

Guidelines for return to school/childcare:

Note: Management of C. difficile is outside of the scope of this pathway 

Reference:

American Academy of Pediatrics, Committee on Infectious Diseases. (2021) Red Book: 2021–2024, Report of the Committee on Infectious Diseases (No. Ed. 32) . American Academy of Pediatrics. https://doi.org/10.1542/9781610025782 

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