Antimicrobial Therapy for Infectious Diarrhea

Acute diarrheal disease may be due to viral, bacterial, or protozoal enteropathogens. In our current state of knowledge and medical practice, specific antiviral agents are not used in the treatment of known or presumed viral diarrhea. In contrast, for a number of the bacterial and protozoal diarrheal infections, therapy with certain antimicrobial agents can significantly ameliorate the severity and duration of illness and curtail the excretion of the pathogen. A recurring theme encountered in reviewing information on the therapy for diarrheal infections is that demonstration of the susceptibility in vitro of a bacterial pathogen to a particular antibiotic by no means assures clinical success. Many antibiotics that show potent activity in vitro have little or no efficacy in vivo. Controlled clinical trials are necessary to assess the clinical and bacteriologic efficacy of an antibiotic in diarrheal infections.