Antibiotic therapy in Acute Diarrhoea

Antibiotics are indicated in the following situations:

• Shigella dysentery - in cases presenting as bloody diarrhoea, these should be treated with an antimicrobial effective for Shigella
• When cholera is suspected
• When diarrhoea is associated with another acute infection such as pneumonia and urinary tract infection
• May be indicated for Salmonella gastroenteritis in very young babies (< 3 months), immune-compromised, immunosuppressed, systemically ill, achlorhydia

Causative Agent by Age

 

Differentiating Viral and Bacterial infection

• Generally, in patients with high fever (>39°C), overt faecal blood, abdominal pain, central nervous system involvement such as irritability, apathy, seizures or coma suggest bacterial aetiology.
• Patients presenting with more significant vomiting and respiratory symptoms suggest viral aetiology
• Rotavirus causes more severe vomiting and dehydration. 
• However, it should be emphasised that the clinical features of both viral and bacterial aetiology overlap considerably.

Adjunctive Antibiotic Therapy

References:

1. Guideline on the Management of Acute Diarrhoea in Children, 2011. ACAD Med
2. Antibiotics for the Empirical Treatment of Acute Infectious Diarrhea in Children. http://www.scielo.br/pdf/bjid/v10n3/a11v10n3