Pre Requirements
African antibiotic treatment guidelines for common bacterial infections & syndromes
Procedure for managing critical microbiological results
People of all ages with acute diarrhea should be evaluated for dehydration, which increases the risk of life-threatening illness and death, especially among the young and older adults.
In immunocompetent children and adults, empiric antimicrobial therapy for bloody diarrhea while waiting for results of investigations is not recommended, except for the following:
- Infants <3 months of age with suspicion of a bacterial etiology
- Ill immunocompetent people with fever documented in a medical setting, abdominal pain, bloody diarrhea, and bacillary dysentery (frequent scanty bloody stools, fever, abdominal cramps, tenesmus) presumptively due to Shigella
- People who have recently travelled internationally with body temperatures ≥38.5°C and/or signs of sepsis
Empiric antibacterial treatment should also be considered in immunocompromised people with severe illness and bloody diarrhea.
Asymptomatic contacts of people with bloody diarrhea should not be offered empiric treatment, but should be advised to follow appropriate infection prevention and control measures.
People with sepsis who are suspected of having enteric fever should be treated empirically with broad-spectrum antimicrobial therapy after blood, stool, and urine culture collection. Antimicrobial therapy should be narrowed when antimicrobial susceptibility testing results become available. If an isolate is unavailable and there is a clinical suspicion of enteric fever, antimicrobial choice may be tailored to susceptible patterns from the setting where acquisition occurred.
Guidelines for adults
For mild/moderate illness & ambulatory therapy
- Ciprofloxacin (PO) 500 mg/12h (3 days)
Alternative antibiotic choice:
- Ceftriaxone (IV) 1g/12h (5 days)
- Azithromycin (PO) 500 mg /d (3 days)
For severe cases or those progressing despite ciprofloxacin, add Entamoeba spp cover
- Metronidazole (PO) 800 mg stat followed by 400 mg 8 hourly (7 days)
Clinical definition: Systemic illness due to S. enterica serotype Typhi or Paratyphi, commonly acquired from ingestion of contaminated food or water. High fever and diarrhea or constipation are common presenting symptoms.
For uncomplicated cases:
Ciprofloxacin (PO) 500 mg/12h
- for mild cases: 7 days
- for severe cases: 10 days
Alternative if quinolone-resistance suspected:
Azithromycin (PO) 500 mg daily (3 days)
For complicated cases
If patient is unable to take oral medication, or in case of confirmed drug allergy or medical contraindication:
Ceftriaxone (IV, with de – escalation to ciprofloxacin or azithromycin depending on fluoroquinolone resistance): 2g daily
- for mild cases: 7 days
- for severe cases: 10 days
Alternative:
Cefixime (PO) 100 mg 12 hourly
- For mild cases: 7 days
- For severe cases: 10 days
Notes
- Obtain a blood culture prior to starting antibiotic therapy
- Median time to fever reduction is 5 days
Campylobacter
- Azithromycin 1000mg/day in one intake, or 500mg/day during 3 days, or 500mg/day day 1 then 250mg/day during 4 days (1500mg in 5 days)
- Ciprofloxacin 500mgx2/day during 3 days
Nontyphoidal Salmonella enterica
- Usually not indicated for uncomplicated infection
- Antimicrobial therapy should be considered for groups at increased risk for invasive infection: neonates (up to 3 months old), persons >50 years old with suspected atherosclerosis, persons with immunosuppression, cardiac disease (valvular or endovascular), or significant joint disease. If susceptible, treatment with ceftriaxone, ciprofloxacin, TMP-SMX, or amoxicillin
Shigella
- Azithromycin 1000mg/day in one intake or 500mg/day for 3 days or 500mg/day day 1 then 250mg/day during 4 days (1500mg in 5 days)
Alternative:
- Ciprofloxacin 500mg x 2/day OR Ceftriaxone 1-2g/day for 3 days
- TMP-SMX OR ampicillin if susceptible
Note
Clinicians treating people with shigellosis for whom antibiotic treatment is indicated should avoid prescribing fluoroquinolones if the ciprofloxacin MIC is 0.12 μg/ mL or higher even if the laboratory report identifies the isolate as susceptible.
Vibrio cholerae
- Doxycycline 300mg/day in one intake
- Ciprofloxacin 1000mg/day in one intake or Azithromycin 1000mg/day in one intake
Non-Vibrio cholerae
- Non invasive disease: usually not indicated
- Invasive disease: ceftriaxone plus doxycycline or TMP-SMX plus an aminoglycoside
Yersinia enterocolitica
- Doxycycline 200mg/day in on intake for 7 days
- Ciprofloxacin 500mgx2/day during 7 days
- TMP-SMX 800/160mg x2/day during 7 days
Guidelines for children
Clinical definition: systemic disease caused by Salmonella species. Clinical features include fever, anorexia, headache, vomiting, constipation or diarrhoea, abdominal pain or tenderness, cough, delirium / altered level of consciousness, hepatomegaly or splenomegaly. Where available, the organism may be cultured from blood (first week of illness) or stool (after first week), urine or bone marrow. A chronic carrier state may occur with ongoing shedding of the organism in stool which may result in transmission to others via contaminated food or water.
Preferred antibiotic choice
For severe disease:
- Ceftriaxone 50mg/kg/12h maximal dose of 2g/12h for 10-14 days
For mild/moderate disease or step down therapy if antibiotic susceptibility results available:
- Ciprofloxacin (PO) 15mg/kg/12h, maximal dose of 500mg/12h, for 10-14 days (total treatment duration including IV therapy, if applicable)
Alternative antibiotic choice:
- Azithromycin (PO) 10mg/kg daily, maximal dose of 500mg, for 5 days
Note
- The patient should ideally be isolated with contact precautions maintained until eradication of the organism from the stool is confirmed on 3 stool samples taken 1 week after completion of antibiotic treatment and every 48 hours thereafter to detect chronic carriage and excretion of the organism
- Prolonged therapy (4 – 6 weeks) is recommended in invasive disease, including bone infections, and in immunocompromised patients (including HIV infection)
Clinical definition: Acute diarrhoea is a serious common childhood illness evidenced by the passing of frequent profuse loose watery stools. Vomiting may or may not be present. Often caused by viral infection but may be due to bacterial infection, dietary or other causes. Antibiotics should not be routinely used for diarrhoeal disease other than when dysentery is present. Features include fever, blood and mucous in stool, leucocytes on stool microscopy, culture of Shigella, Salmonella, pathogenic E. coli or Campylobacter species.
Preferred antibiotic choice
For mild/ moderate illness & ambulatory therapy:
- Ciprofloxacin (PO) 15mg/kg/12h, maximal dose of 500mg/12h, for 3-5 days
For moderate/ severe illness requiring hospital admission:
- Ceftriaxone 50mg/kg/dose once daily, maximal dose of 1g, for 3-5 days
Alternative antibiotic choice:
- Azithromycin (PO) 10mg/kg daily, maximal dose of 500mg, for 3-5 days
In regions where amoebiasis is common
- Metronidazole (PO) 15mg/kg/8h, maximal dose of 800mg/8h, for 7-10 days
Note
- Where stool culture and AST is available, adjust treatment according to current susceptibility of the organism
- For immunocompromised patients with Salmonella infections (e.g. patients with sickle cell disease), increase duration of therapy to 14 days
- Prevention and treatment of dehydration