Clinical definition:
Acute diarrhoea is a serious common childhood illness evidenced by the passing of frequent profuse loose watery stools. Vomiting may or may not be present. Often caused by viral infection but may be due to bacterial infection, dietary or other causes. Antibiotics should not be routinely used for diarrhoeal disease other than when dysentery is present. Features include fever, blood and mucous in stool, leucocytes on stool microscopy, culture of Shigella, Salmonella, pathogenic E. coli or Campylobacter species.
| Neonate | |||
| Diarrhoeal disease is uncommon in neonates. See section on Possible Serious Bacterial Infection for treatment guidance. | |||
| Infant, Child & Adolescent | |||
| Preferred antibiotic choice for suspected or confirmed dysentery | |||
| Drug | Formulation | Dosage | Duration |
| For mild/moderate illness & ambulatory therapy: Ciprofloxacin (PO) | Oral liquid: 250 mg/5 mL (anhydrous) ; Tablet: 250 mg (as hydrochloride) | 15 mg/kg/dose 12 hourly, maximum dose 500 mg 12 hourly | 3 – 5 days |
| For moderate/severe illness requiring hospital admission: Ceftriaxone (IV) | Powder for injection: 250 mg, 1 g (as sodium slat) in vial | 50 mg/kg/dose once daily, maximum dose 1 g | |
| Alternative antibiotic choice(s) for suspected or confirmed dysentery | |||
| Azithromycin (PO) | Oral liquid: 200 mg/5 mL; Capsule: 250 mg. 500 mg (anhydrous) | 10 mg/kg/dose daily, maximum dose 500 mg | 3 – 5 days |
| In regions where amoebiasis is common | |||
| Metronidazole (PO) | Oral liquid: 200 mg (as benzoate) / 5 mL; Tablet: 200 mg to 500 mg | 15 mg/kg/dose 8 hourly, maximum dose 800 mg 8 hourly | 7 – 10 days |
| In regions where cholera is endemic or where outbreaks are occurring | |||
| Azithromycin (PO) | Oral liquid: 200 mg/5 mL. Capsule: 250 mg. 500 mg (anhydrous) | 10 mg/kg/dose daily, maximum dose 500 mg | 3 – 5 days |
Principles of Stewardship:
- In an epidemic context and where stool culture and AST is available, adjust treatment according to current susceptibility of the organism.
Notes:
- For immunocompromised patients with Salmonella infections (e.g. patients with sickle cell disease), increase duration of therapy to 14 days.
- Prevention and treatment of dehydration and/or hypovolaemic shock with careful fluid management is essential.