ANTIMICROBIAL THERAPY AND PROPHYLAXIS

Empirical antimicrobial therapy is indicated in patients with diarrhoe a who have high fever and systemic toxicity, dysenteric disease, or tr avellers' diarrhoea. Antimicrobials are essential for those with sever e shigellosis and amoebiasis. They are useful or possibly useful for o ther forms of diarrhoeal disease including amoebiasis (milder forms), campylobacteriosis, cholera, giardiasis, shigellosis, and diarrhoea du e to a variety of other laboratory-defined bacterial enteropathogens. Furazolidone is useful in infantile giardiasis and mildly effective in other forms of bacterial diarrhoea. Trimethoprim/sulphamethoxazole is effective against Shigella spp. in most parts of the world. Erythromy cin is considered the treatment of choice for campylobacteriosis. For adults, the quinolone antimicrobials represent the most useful class o f drugs for bacterial enteropathogens. Several dilemmas currently exis t in the area. They include the lack of drugs for the therapy of trime thoprim-resistant shigellosis in children, overuse of antimicrobials i n the developing world, and the potential for post-treatment prolongat ion of intestinal excretion of non-typhoid salmonellae. Antimicrobial chemoprophylaxis can be used in the rare person from an industrialized area during brief travels to a tropical region who has a serious unde rlying medical problem, cannot exercise care in what is eaten and drun k, and will have the purpose of the trip put at jeopardy should any il lness develop (even that rendered short-term by effective therapy). Fo r most people, therapy of illness is preferred to prophylaxis.