The Griffin Report. Report of the Independent Investigation Committee June 2010. Review of the major outbreak of E. coli O157 in Surrey, 2009 An evaluation of the outbreak and its management, with a consideration of the regulatory framework and control of risks relating to open farms. 2010 www.griffininvestigation.org.uk Accessed 23.09.14.

Farthing M, Feldman R, Finch R, Fox R, Leen C, Mandal B, Moss P, Nathwani D, Nye F, Percival A, Read R, Ritchie L, Todd WT, Wood M. The management of infective gastroenteritis in adults. A consensus statement by the British Society for the Study of Infection. J Infect 1996;33:143-52. RATIONALE: Empirical treatment for patients well enough to be managed in primary care is not recommended because the majority of illnesses seen in the community do not have an identifiable bacterial cause. In addition, an RCT of quinolones as empiric therapy found no benefit in patients whose stool cultures were negative.

Public Health England and the British Infection Association recommend that, if campylobacter is strongly suspected as the cause of diarrhoea, consider empirical treatment with clarithromycin. Quinolones are not recommended because there is increasing resistance of campylobacter to quinolones, and broad spectrum antibiotics such as quinolones are not recommended for empirical therapy because they are associated with an increased risk of Clostridium difficile, MRSA, and antibiotic resistance including resistant UTIs.

E coli 0157 Independent Investigation Committee. Review of the major outbreak of E coli 0157 in Surrey, 2009. http://www.griffininvestigation.org.uk/ Accessed 23.09.14. The Griffin report recommends that E coli 0157 should be suspected in any child presenting with bloody diarrhoea.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).