What is the treatment for enteritis in a 2-year-old?

Treatment of Enteritis in a 2-Year-Old Child

The cornerstone of treatment for enteritis in a 2-year-old is oral rehydration therapy using reduced osmolarity oral rehydration solution (ORS), with antibiotics reserved only for specific bacterial causes or severe cases with systemic symptoms. 1

Assessment of Dehydration

Evaluate the child's hydration status first, as this determines the urgency and approach to treatment:

• Key physical examination findings to assess dehydration:

  • General appearance
  • Capillary refill time
  • Skin turgor
  • Mucous membranes
  • Tear production
  • Respiratory pattern
  • Urine output 1, 2

• The most useful predictors of significant dehydration (≥5%) are:

  • Abnormal capillary refill
  • Abnormal skin turgor
  • Abnormal respiratory pattern 2

Treatment Approach

1. Rehydration

• For mild dehydration:

  • Oral rehydration therapy at home
  • Half-strength apple juice followed by the child's preferred liquids 3
  • Continue age-appropriate diet during or immediately after rehydration 1

• For moderate dehydration:

  • Standard glucose-electrolyte ORS with composition of:
    • 75-90 mEq/L sodium
    • 20 mEq/L potassium
    • 65-80 mEq/L chloride
    • 10 mEq/L citrate
    • 75-111 mmol/L glucose 1

• For severe dehydration:

  • Intravenous fluids and hospitalization 1, 3

2. Dietary Management

• Follow BRAT diet (bread, rice, applesauce, toast) 1
• Avoid:
  • Lactose-containing products
  • High-osmolar supplements
  • Foods high in simple sugars and fats 1
• Offer food every 3-4 hours 1

3. Pharmacological Treatment

• Antimotility agents:

  • Loperamide should NOT be given to children under 2 years of age 1
  • Antimotility drugs are contraindicated in children <18 years with acute diarrhea 1

• Antiemetics:

  • Ondansetron may be considered if vomiting is preventing oral rehydration 3, 2
  • Benefits include less vomiting, greater oral intake, and reduced need for IV rehydration 2

• Antibiotics:

  • Not routinely recommended for uncomplicated gastroenteritis 1

  • Consider only if:

    • Evidence of bacterial infection
    • Immunocompromised status
    • Severe illness with systemic symptoms 1

  • For bacterial enteritis in pediatric patients, acceptable regimens include:

    • Aminoglycoside-based regimen
    • Carbapenem (imipenem, meropenem, or ertapenem)
    • β-lactam/β-lactamase inhibitor combination
    • Advanced-generation cephalosporin with metronidazole 4

When to Seek Medical Attention

Parents should seek immediate medical care if:

• No improvement within 48 hours
• Worsening symptoms
• Persistent fever
• Abdominal distension
• Blood in stool
• Signs of severe dehydration 1

Prevention

• Handwashing
• Breastfeeding (if applicable)
• Rotavirus vaccination 3
• Appropriate infection control measures 1

Important Caveats

• Laboratory tests are not routinely needed for mild cases when viral gastroenteritis is suspected 3
• Oral rehydration is as effective as intravenous rehydration for preventing hospitalization in mild to moderate cases 3, 5
• For every 25 children treated with ORT, one may fail and require IV therapy 5
• Avoid routine use of antibiotics as this may contribute to antimicrobial resistance and potentially worsen certain infections like C. difficile 1, 6

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