What is the recommended antibiotics regimen for bacterial gastroenteritis in children?

Antibiotic Regimen for Bacterial Gastroenteritis in Children

Antibiotics should NOT be routinely prescribed for most cases of pediatric gastroenteritis as the majority are viral in origin and will resolve without antimicrobial therapy. 1, 2

When to Consider Antibiotics

Antibiotics should only be considered in the following specific situations:

1. Infants < 3 months of age with suspected bacterial etiology 1
2. Bloody diarrhea (dysentery) with fever, suggesting shigellosis 1, 2
3. Persistent high fever with systemic symptoms 2
4. Diarrhea lasting > 5 days without improvement 2
5. Confirmed bacterial pathogen requiring treatment 1, 3
6. Immunocompromised patients with severe illness and bloody diarrhea 1

Recommended Antibiotic Regimens by Age and Pathogen

For Infants < 3 Months

• First-line: Third-generation cephalosporin (e.g., cefotaxime 150-200 mg/kg/day divided every 6-8 hours) 1, 2

For Children > 3 Months with Suspected Bacterial Infection

• First-line: Azithromycin 1, 2, 3
  • Dosage: 10 mg/kg on day 1 (max 500 mg), then 5 mg/kg daily for 4 days (max 250 mg/day)

Pathogen-Specific Treatment (When Identified)

1. Shigella

   • First-line: Azithromycin 1, 3, 4
   • Alternative: TMP-SMX (if susceptible) 5 mg/kg TMP component twice daily for 3 days 1

2. Campylobacter (only for severe cases or early in illness)

   • First-line: Azithromycin 3, 4
   • Alternative: Erythromycin 500 mg twice daily for 5 days 1

3. Salmonella (only for severe infection, infants <6 months, or patients with prostheses/valvular heart disease)

   • First-line: Ceftriaxone 50-75 mg/kg/day 3, 4
   • Alternative: Ciprofloxacin (for children >18 years) 3, 4

4. Enterotoxigenic E. coli (ETEC)

   • If treatment needed: TMP-SMX (if susceptible) or azithromycin 1

Important Considerations and Cautions

• Do not use antibiotics for E. coli O157:H7 or other Shiga toxin-producing E. coli (STEC) as they may increase the risk of hemolytic uremic syndrome 1

• Avoid antimotility agents (e.g., loperamide) in children with bloody diarrhea or suspected inflammatory diarrhea 1, 2

• Adjust therapy based on culture and susceptibility results when available 1

• Duration of therapy is typically 3-5 days for most pathogens 1

• Empiric treatment without bacterial identification should generally be avoided except in severe cases or high-risk patients 3, 4

Supportive Care (Critical Alongside Antibiotic Decisions)

• Oral rehydration therapy remains the cornerstone of treatment for all forms of gastroenteritis 1, 2

• Continue breastfeeding throughout the illness 2

• Resume age-appropriate diet within 4-6 hours of initial rehydration 2

• Monitor for signs of dehydration including urine output, vital signs, and electrolytes 2

Warning Signs Requiring Immediate Medical Attention

• Persistent vomiting preventing oral rehydration
• High stool output (>10 mL/kg/hour)
• Worsening dehydration despite treatment
• Lethargy or altered mental status 2

The decision to use antibiotics should always be weighed against the risk of promoting antimicrobial resistance, which is a growing concern worldwide for enteric pathogens 3, 5.