Dysentery

Antibiotic therapy does not affect the clinical course in most cases of acute diarrhea. Patients with uncomplicated Salmonella gastroenteritis should not be given antibiotics unless they appear septic or are bacteremic, have a hemoglobinopathy, or have an underlying chronic gastrointestinal disorder. However, infants younger than 6 months of age are generally treated with antibiotics because of their overall risk of bacteremia or suppurative disease. If a child has had diarrhea lasting longer than 10 to 14 days and has a significant fever, systemic complaints, and inflammatory cells or blood in the stool, then empiric antimicrobial treatment may be indicated after sending a stool sample for bacterial culture. Therapy should provide coverage for the usual dysenteric agents ( Shigella, Salmonella, and Campylobacter), and either ampicillin or trimethoprim-sulfamethoxazole are reasonable choices. Debilitated patients, children with underlying gastrointestinal disorders, immunocompromised children, and children with severe bloody diarrhea should be treated with oral antibiotics 15 (Table.., „12.2.-4).

Children who have been receiving antibiotics and develop bloody diarrhea may have antibiotic-associated colitis. Most cases of antibiotic-associated colitis caused by Clostridium difficile resolve spontaneously when antibiotics are discontinued. Infants and children with protracted diarrhea that has not improved after discontinuing antibiotics may benefit from receiving cholestyramine [2 (g/kg)/day divided into three equal doses]. Cholestyramine is an anion-exchange resin that adsorbs C. difficile cytotoxin.

Several antidiarrheal drugs are available to alter intestinal motility, decrease secretions, and adsorb toxins or fluids to reduce diarrhea. Few published data are available, though, to support the use of these agents for treating acute diarrhea in children. Antimotility agents should not be used to treat acute diarrhea in children. 16

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