Recent advances in management of bacterial diarrhea

The number of recognized infectious causes of diarrhea potentially treatable with specific antibiotics has markedly increased within the past ten years. Laboratories are developing and expanding their abilities to deal with these new pathogens. Neither prophylaxis nor specific treatment of diarrhea in travelers is simple, practical, and safe. Although enterotoxigenic Escherichia coli is the most important cause of diarrhea in U.S. travelers to tropical areas, Campylobacter jejuni causes acute diarrhea in persons in the United States about as often as do Salmonella and Shigella. Vibrio parahemolyticus is an important cause of outbreaks of gastroenteritis following ingestion of improperly cooked shellfish; Bacillus cereus is important in outbreaks of diarrhea after ingestion of improperly cooked and stored rice in Chinese restaurants. Although Yersinia enterocolitica is probably an important cause of severe enteritis in the United States, imperfect techniques for its isolation and lack of good serologic tests have hampered recognition of its importance. Practical means for diagnosing antibiotic-associated colitis and the role of Clostridium difficile toxins in this disease are now available. Vancomycin, metronidazole, bacitracin, and cholestyramine are useful in treatment of antibiotic-associated colitis.