This patient has acute diarrhea consistent with mild Salmonella gastroenteritis, which requires no therapy at this time. Nontyphoidal Salmonella infections typically cause an inflammatory diarrhea, sometimes associated with fever and abdominal pain. In young, healthy persons, such as this patient, the illness is usually self-limited and resolves without antibiotic therapy. In this population, antibiotic therapy is associated with prolonged asymptomatic fecal shedding with no decrease in duration of diarrhea. In contrast, Salmonella gastrointestinal infection in older patients, immunocompromised patients, or patients with sickle cell disease is associated with an increased risk for bacteremia and endovascular infection. In these populations, as well as in patients with severe salmonellosis or those requiring hospitalization, antibiotic therapy is warranted.

Azithromycin is the preferred empiric treatment option for Campylobacter gastroenteritis, considering increasing rates of quinolone resistance for this bacterium.

Ciprofloxacin is effective for most bacterial agents causing gastroenteritis but should be reserved for febrile patients with moderate to severe inflammatory diarrhea when the suspicion for Salmonella or Shiga toxin–producing Escherichia coli is low.

Loperamide and other antimotility agents are not recommended for inflammatory diarrhea because of the potential for delaying bacterial clearance and prolonging the illness.

Most studies of probiotics for infectious diarrhea have been performed in children. In that population, probiotics have been associated with an average decrease in the duration of symptoms by 1 day; however, the benefit for adults is less certain.