* Antibiotics are not indicated in most cases but may be used supportively with IV fluids to treat infections caused by specific organisms.

† Resistance is increasing.

‡ Antibiotic selection should be guided by susceptibility testing when available because resistance to doxycycline, fluoroquinolones, and sulfamethoxazole/trimethoprim (SMX/TMP) is increasing in certain areas and strains. In general, doxycycline is the recommended first-line antibiotic for non-pregnant adults. Azithromycin is first-line for children and pregnant women and 2nd-line for others. Other recommendations vary, but SMX/TMP is generally a 2nd-line antibiotic for children if the strain in an outbreak is susceptible. Ciprofloxacin is 2nd- or 3rd-line in non-pregnant adults and, although generally avoided in children, can be used as 2nd line if strains are resistant to SMX/TMP.

§ This antibiotic should not be given to pregnant women.

‖ Metronidazole is not recommended but may be used in patients intolerant of vancomycin and fidaxomicin.

¶ Treatment should be followed by a course of iodoquinol for 20 days or paromomycin for 7 days.