Antimicrobial therapy for gastrointestinal, pancreatic, and hepatic disorders

Antimicrobials are a common part of a symptomatic approach to the treatment of gastrointestinal disorders. Without an etiologic diagnosis, antimicrobial therapy is likely to be of little value and, in the worst case, may harm the patient either by altering normal gastrointestinal flora or by producing direct toxicity. This review is a systematic appraisal of antimicrobial therapy for gastrointestinal disease, beginning with the oral cavity, proceeding through the gastrointestinal tract and concluding with pancreatic and hepatic disorders. The intent is to highlight specific etiologies which form the basis for rational therapeutic choices. Controversies concerning the need for antimicrobial therapy or therapeutic alternatives are also explored. The review concludes with a discussion of adverse gastrointestinal effects of antimicrobial therapy.