Role of antimicrobials in the treatment of adult patients presenting to the emergency department with acute gastroenteritis - A mini review

Abstract

Background & Objective:Acute gastroenteritis is generally considered a self-limiting illness that does not require the use of antibiotics. However, many emergency departments in the country frequently prescribe antibiotics to patients presenting with diarrhoea. This review attempts to determine whether this practice is reasonable. Our objective was to determine the role of antimicrobials in the empiric management of acute gastroenteritisMethods:The online data base “PubMed”, as well as the World Wide Web, were searched for relevant articles (RCTs, Reviews, Prospective studies, etc.) with key words such as “gastroenteritis AND antibiotics”, “Management AND gastroenteritis”, “Treatment AND diarrhoea” etc. and covered the years 1960-2016. Fifty articles were studied, of which 43 were chosen on the basis of relevance for qualitative assessment.Results:The articles reviewed for this paper suggest that antimicrobial therapy is not appropriate for the majority of cases of (uncomplicated) gastroenteritis, as risks (antibiotic-associated diarrhoea, hypersensitivity reactions, etc.) outweigh benefits. However, there are instances where antibiotics are clearly indicated. Further, it is noted that there have not been any recent trials to clarify the role of antimicrobials in adult diarrhoeal illness.Conclusions:The focus in management of patients presenting with diarrhoea in the Emergency Department should be on rehydration and that only certain patients, such as those with fever or dysentery, or those with an impaired immune response should receive empiric antimicrobial therapy. More studies are needed to determine in what instances antimicrobials are of greatest benefit, so that adverse effects of rampant antibiotic prescription can be curtailed.

Antimicrobial resistantSalmonellaspp. circulating in antibiotic-free organic pig farms of northern-Thailand

“…All 28 detected Salmonella strains were susceptible to norfloxacin and ciprofloxacin, both of which are fluoroquinolones, which is necessary in parenteral treatment of severe gastroenteritis cases [36,37]. Fluoroquinolones remain the most effective antimicrobials for pig related salmonellosis in humans.…”

Erişkin akut gastroenterit olgularında etiyolojik ajanlar

“…Günümüzde enfeksiyöz ishallerin tanı ve tedavisinde kayda değer gelişmeler sağlanmış olmasına rağmen, dünyada büyük sorun haline gelen antimikrobiyal direnç nedeniyle enterik enfeksiyonların tedavisinde akılcı ve kanıta dayalı antibiyotik kullanımı zorunlu hale gelmiştir [14][15][16] . AGE tedavisinde ampirik antibiyotik reçete edilmesi yaygın bir tutumdur 17 . İshalli hastalıkların büyük bir bölümü kendi kendini sınırlayabilen enfeksiyonlardır [14][15][16][17] .…”

“…AGE tedavisinde ampirik antibiyotik reçete edilmesi yaygın bir tutumdur 17 . İshalli hastalıkların büyük bir bölümü kendi kendini sınırlayabilen enfeksiyonlardır [14][15][16][17] . AGE olgularının da aralarında olduğu birçok enfeksiyon hastalığı için uygun olmayan antibiyotik kullanımı tedavi maliyetinde artma, hastalarda istenmeyen etki, ilaç etkileşimleri ve toplumda antimikrobiyal direnç geliştirme potansiyeli taşımaktadır.…”

Cecropin A-melittin mutant is a potential therapeutic agent in treating bacterial gastroenteritis

“…The re-emergence of gastroenteritis caused by multidrug-resistant bacteria presents a serious challenge to clinicians [1], and the development of novel treatment strategies is needed. The use of antimicrobial peptides (AMPs) offers a potential chemotherapeutic strategy to target drug-resistant bacterial pathogens [2][3][4][5].…”