Abstract
Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler’s diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.
Highlights
Acute gastroenteritis (AGE) is one of the most common problems in infants and young children, especially in poor countries
Overuse of antibiotics is associated with increased rates of antibiotic-resistant bacteria, unnecessary costs, and significant incidence of adverse events, and current guidelines are highly restrictive in recommending empiric antimicrobial therapy for AGE
Antimicrobial prescribing patterns for acute gastroenteritis in developing and developed countries Antibiotic therapy is sometimes recommended to shorten the duration and severity of symptoms of AGE as well as to decrease its transmission[19,20]
Summary
Acute gastroenteritis (AGE) is one of the most common problems in infants and young children, especially in poor countries. Non-bloody diarrhea should be managed with fluids only (unless co-morbidities are present that may require a different treatment), while dysentery (reported history of blood in the stools since diarrheal onset) should be managed with antibiotics, as Shigella infection is suspected[23] This approach is supported by the evidence that most non-bloody diarrheal episodes in children under 5 years of age in low-income settings are self-limiting and are caused by viral pathogens (rotavirus, norovirus, astrovirus, and enteric adenovirus) or pathogens for which antibiotics are likely of limited efficacy or even dangerous (e.g. Salmonellae and Campylobacter)[24]. International guidelines state that children with underlying immune deficiency, anatomical or functional asplenia, corticosteroid or immunosuppressive therapy, cancer, inflammatory bowel disease (IBD), or achlorhydria should receive antibiotics when bacterial gastroenteritis is suspected This approach appears logical, data on efficacy are lacking, the grade of evidence is weak, and there is no list of specific chronic conditions that require antibiotic therapy for diarrhea.
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