Sandbox/diarrhea

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Pathogen Specific

▸ Click on the following categories to expand treatment regimens.

Shigella species   ▸  Adults   ▸  Children Non-typhi species of Salmonella   ▸  Adults   ▸  Children Campylobacter species   ▸  Adults   ▸  Children Escherichia coli species   ▸  Enterotoxigenic   ▸  Enteropathogenic   ▸  Enteroinvasive   ▸  Enteroaggregative   ▸  Enterohemorrhagic (STEC) Aeromonas / Plesiomonas   ▸  Adults   ▸  Children Yersinia species   ▸  Adults   ▸  Children Vibrio cholerae O1 or O139   ▸  Adults   ▸  Children Toxigenic Clostridium difficile   ▸  Adults   ▸  Children Parasites   ▸  Giardia   ▸  Cryptosporidium species   ▸  Isospora species   ▸  Cyclospora species   ▸  Microsporidium species   ▸  Entamoeba histolytica

Immunocompetent patients Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 3 days Alternative Regimen ▸ Ofloxacin 300 mg orally q12h X 3 days OR ▸ Norfloxacin 400 mg orally q12h X 3 days OR ▸ Ciprofloxacin 500 mg orally q12h X 3 days OR ▸ Nalidixic acid 1g orally q24h X 5 days OR ▸ Ceftriaxone X 3 days OR ▸ Azithromycin X 3 days Immunocompromised patients Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 7-10 days Alternative Regimen ▸ Ofloxacin 300 mg orally q12h X 7-10 days OR ▸ Norfloxacin 400 mg orally q12h X 7-10 days OR ▸ Ciprofloxacin 500 mg orally q12h X 7-10 days OR ▸ Nalidixic acid 1g orally q24h X 7-10 days OR ▸ Ceftriaxone X 7-10 days OR ▸ Azithromycin X 7-10 days Immunocompetent patients Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 3 days Alternative Regimen ▸ Nalidixic acid 55 mg/kg/day X 5 days OR ▸ Ceftriaxone X 3 days OR ▸ Azithromycin X 3 days Immunocompromised patients Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 5/25 mg/kg orally q12h X 7-10 days Alternative Regimen ▸ Nalidixic acid 55 mg/kg/day X 7-10 days OR ▸ Ceftriaxone X 7-10 days OR ▸ Azithromycin X 7-10 days Immunocompetent Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 5-7 days Alternative Regimen ▸ Ofloxacin 300 mg orally q12h X 5-7 days OR ▸ Norfloxacin 400 mg orally q12h X 5-7 days OR ▸ Ciprofloxacin 500 mg orally q12h X 5-7 days OR ▸ Ceftriaxone 100 mg/kg/day in 2-3 divided doses Immunocompromised patients Preferred Regimen ▸ Trimethoprim-sulfamethoxazole 160/800 mg orally q12h X 14 days Alternative Regimen ▸ Ofloxacin 300 mg orally q12h X 14 days OR ▸ Norfloxacin 400 mg orally q12h X 14 days OR ▸ Ciprofloxacin 500 mg orally q12h X 14 days OR ▸ Ceftriaxone 100 mg/kg/day in 2-3 divided doses X 14 days Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen (beta-lactam allergy) ▸ Clindamycin 20 to 30 mg/kg/day orally in 4 divided doses PLUS ▸ Trimethoprim component 8 mg/kg/day orally in 2 divided doses Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h OR ▸ Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses OR ▸ Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h OR ▸ Amoxicillin-clavulanate 500/125 mg orally q8h Alternative Regimen (beta-lactam allergy) ▸ Doxycycline 100 mg orally q12h OR ▸ Cefuroxime 500 mg orally q12h Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 1.5 to 3 g IV q6-8h OR ▸ Piperacillin-tazobactam 3.375 gm IV q6-8h OR ▸ Ertapenem 1 gm IV q24h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Meropenem 1 gm IV q8h Alternative Regimen (beta-lactam allergy) ▸ Cefazolin 1 gm IV q8h OR ▸ Cefuroxime 1 gm IV q24h OR ▸ Cefoxitin 1 gm IV q6-8h OR ▸ Ceftriaxone sodium 1 gm IV q12h OR ▸ Cefotaxime 2 gm IV q6h OR ▸ Ciprofloxacin 400 mg IV q12h OR ▸ Moxifloxacin 400 mg IV q24h Cat scratch disease Preferred Regimen ▸ Azithromycin 500 mg orally on day 1, then 250 mg orally once daily X 4 days Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen ▸ Cefuroxime 10 to 15 mg/kg orally q12h Cat scratch disease Preferred Regimen ▸ Azithromycin 10 mg/kg orally on day 1, then 5 mg/kg orally X 4 days Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h OR ▸ Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses OR ▸ Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily High risk bites (deep bites, symptomatic animals Preferred Regimen (without CNS symptoms) ▸ Acyclovir 12.5–15 mg per kg IV q8h OR ▸ Ganciclovir 5 mg per kg IV q12h Preferred Regimen (with CNS symptoms) ▸ Ganciclovir 5 mg per kg IV q12h High risk bites (deep bites, symptomatic animals Preferred Regimen (without CNS symptoms) ▸ Acyclovir 12.5–15 mg per kg IV q8h OR ▸ Ganciclovir 5 mg per kg IV q12h Preferred Regimen (with CNS symptoms) ▸ Ganciclovir 5 mg per kg IV q12h Uncomplicated Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h Alternative Regimen (beta-lactam allergy) ▸ Doxycycline 100 mg orally q12h Rat bite fever Preferred Regimen ▸ Penicillin G benzathine 600,000 to 1,000,000 units/day IM X 10-14 days OR ▸ Tetracycline 250 to 500 mg orally q6h Alternative Regimen ▸ Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen ▸ Cefuroxime 10 to 15 mg/kg orally q12h Rat bite fever Preferred Regimen ▸ Penicillin G benzathine 25,000 to 50,000 units/day IM X 10-14 days OR ▸ Tetracycline (>8 years) 25 to 50 mg/kg/day orally in 4 divided doses X 10-14 days Alternative Regimen ▸ Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days Pig (Swine) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days Alternative Regimen ▸ Ampicillin sulbactam OR ▸ Imipenem OR ▸ Cephalosporin Pig (Swine) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days Alternative Regimen ▸ Ampicillin sulbactam OR ▸ Imipenem OR ▸ Cephalosporin Suspected Leptospirosis Preferred Regimen ▸ Doxycycline 200 mg orally once within 72 hours of tick removal Suspected Leptospirosis Preferred Regimen ▸ Doxycycline (≥8 years) 4 mg/kg (maximum 200 mg) orally once within 72 hours tick removal