Community-acquired Diarrheal Disease in Western Countries: Applications of Nonabsorbable Oral Antibiotic Therapy*

Infectious diarrhea can be caused by bacteria, viruses, and protozoa. When bacterial pathogens are involved, antibiotics are a mainstay of treatment because they alleviate symptoms and reduce duration of disease, prevent transmission of disease by eradicating pathogens from the stool, and arguably prevent long-term sequelae. These benefits notwithstanding, the use of antibiotics for bacterial diarrheal illness is associated with several challenges and limitations that should be borne in mind in therapeutic decision making. This paper discusses some of the challenges in the use of antibiotics for the management of bacterial diarrheal illness and considers the utility of nonabsorbed or poorly absorbed oral antibiotics in meeting these challenges. Nonabsorbed oral antibiotic therapy, unlike systemically available antibiotics, allows localized enteric targeting of pathogens and is associated with minimal risk of systemic toxicity or side effects. Provided that nonabsorbed antibiotics are as effective as systemically absorbed drugs for the target illness, their benign safety and tolerability profiles may render them more suitable than systemically available antibiotics for certain patient groups, such as young children, pregnant or lactating women, and the elderly, among whom side effects are a particular concern. The limited use of nonabsorbed oral antibiotics only for enteric infections should also limit the development of widespread resistance—a major limitation of current antibiotics for enteric infections. (Adv Stud Med. 2003;3(10A):S945-S950)