GASTROINTESTINAL - Diarrhea, Acute, Empiric Therapy (Shigella, Escherichia coli, Salmonella) Note: Most patients do not require antimicrobial therapy. Consider empiric therapy for patients with fever, bloody stools, or prolonged symptoms. Empiric antibiotic therapy for acute diarrhea in children is not recommended. Early antibiotic therapy, especially with TMP/SMX, in children infected with E. coli 0157:H7, may be associated with hemolytic uremic syndrome.
Ciprofloxacin* (Cipro^®) Pregnancy: C; Lactation: Unsafe Tabs: 250 mg, 500 mg, 750 mg Use with antimotility drug such as loperamide (Imodium^®) if no fever or blood in stool.	³18 and Adult, Mild to Moderate: Fluids +/- antimotility drugs. ³18 and Adult, Severe: 500 mg PO twice daily for 3-5 days.	Food: Take on empty stomach 1 hour before or 2 hours after a meal. May take with food if it causes GI upset, but avoid large amounts of dairy products. May take 2 hours before or 6 hours after sucralfate, antacids, aluminum, magnesium, calcium, zinc, iron, sucralfate, vitamins, or mineral supplements. Important side effects: Photosensitivity,dizziness. Reduce dose in renal disease (CrCl <50 mL/min).
Levofloxacin* (Levaquin^®) Pregnancy: C; Lactation: Unsafe Tabs: 250 mg, 500 mg Use with antimotility drug such as loperamide (Imodium^®) if no fever or blood in stool.	³18 and Adult: 500 mg Q24H 3-5 days.	Food: May take with or without meals. Do not take within 2 hours of antacids, magnesium, calcium supplements, aluminum, sucralfate, vitamins, or minerals (iron or zinc). Important side effects: Photosensitivity,dizziness. Reduce dose in renal disease (CrCl <50 mL/min).
Trimethoprim/Sulfamethoxazole* (Bactrim^®, Septra^®, Cotrim^®) Generics available Pregnancy: C; Lactation: Unsafe Single Strength (SS) Tabs: 80 mg/400 mg Double Strength (DS) Tabs: 160 mg/800 mg Susp: 40 mg/200 mg/5 ml	Adult, Mild to Moderate: Fluids ± antimotility drugs. Adult, Severe: 1 DS Tab PO twice daily for 3-5 days.	Food: May take without regard to food. Encourage fluids. Important side effects: Photosensitivity, rash. Reduce dose in renal disease (CrCl <30 mL/min).