SWAB guidelines for antimicrobial therapy of acute infectious diarrhoea

The Dutch Working Party on Antibiotic Policy (SWAB: Stichting Werkgroep Antibioticabeleid) develops evidence-based guidelines for the use of antibiotics in hospitalised adults. In this article we discuss the guideline on antibiotic treatment of acute infectious diarrhoea (AID). AID can be subdivided into community-acquired diarrhoea, traveller's diarrhoea and hospital-acquired (nosocomial) diarrhoea. For the first two categories, the need for antibiotic treatment is generally restricted to individuals with severe illness, dysentery and/or a predisposition to complications. Infection with Campylobacter species is the most common cause of bacterial AID in the Netherlands. In human Campylobacter isolates in the Netherlands, but also in other parts of the world, high rates of primary fluoroquinolone resistance are prevalent. If antibiotic treatment in community-acquired AID and AID in travellers on return to the Netherlands is indicated, it is therefore advised to use oral azithromycin for three days as empirical treatment. If intravenous treatment is necessary, the combination of ciprofloxacin and erythromycin for five to seven days may be used. As soon as the identity of the causative organism is known, antimicrobial treatment should be tailored accordingly