Consequences of treatment of gastrointestinal infections.

Diarrhoeal disease is a common problem in developing countries. As a result of recent advances in diagnostic methodology, the causative agents can now be identified in most cases of acute diarrhoeal diseases. Enteric bacterial pathogens are the common cause of gastroenteritis in developing countries. Appropriate uses of antibiotics in selected cases of diarrhoea will decrease symptoms or reduce faecal shedding of the organism and prevent spread of infection. Antimicrobial agents improve the diarrhoea associated with cholera, shigellosis, enteric fever, enterotoxigenic Escherichia coli, giardiasis, amoebiasis, and probably Vibrio parahaemolyticus, and enteropathogenic E. coli. Antibiotics have no role in the treatment of viral diarrhoea or uncomplicated salmonella gastroenteritis. Most of the diarrhoeal diseases are self-limited and the wrong choice of antimicrobial agents will worsen the symptoms. Treatment of gastrointestinal infections with antimicrobials will change intestinal microflora, promote the emergence of resistant strains and overgrowth of potential pathogenic bacteria and fungi. Risks and benefits should be considered before prescribing antimicrobial agents.