What is the best course of treatment for a 9-year-old male with a 6-7 day history of nausea, vomiting, and watery diarrhea after eating at a fast food restaurant, who is currently stable and hydrated?

Treatment for a 9-Year-Old with Acute Gastroenteritis

For this 9-year-old with acute watery diarrhea from presumed foodborne illness who is well-hydrated and tolerating oral fluids, continue oral rehydration therapy and resume normal diet—antibiotics are not indicated. 1, 2

Primary Management: Supportive Care Only

Oral rehydration and nutritional support are the cornerstones of treatment for this patient. 1, 2

• Continue oral rehydration solution (ORS) to replace ongoing stool losses until diarrhea resolves, even though the patient is currently well-hydrated 1, 2
• Resume age-appropriate normal diet immediately—there is no need to restrict foods or use special diets like BRAT 1, 2
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice, presweetened cereals) as these can worsen diarrhea through osmotic effects 1
• Include starches, cereals, yogurt, fruits, and vegetables in the diet 1

Why Antibiotics Are NOT Indicated

Empiric antimicrobial therapy is not recommended for acute watery diarrhea without recent international travel in immunocompetent children. 1, 2

This patient does not meet any criteria for antibiotic use:

• No fever (which would suggest invasive bacterial infection) 1, 2
• No bloody stools (which would suggest Shigella or other invasive pathogens) 1, 2
• No signs of sepsis or severe systemic illness 1
• No immunocompromising conditions 1, 2
• No recent international travel 1, 2
• Well-hydrated and tolerating oral intake 1, 2

The clinical picture is most consistent with viral gastroenteritis (likely norovirus) from a common-source foodborne outbreak, which does not respond to antibiotics. 3, 4

Medications to AVOID

Do not use antimotility agents (loperamide) in children under 18 years of age with acute diarrhea. 2, 5

• Loperamide is contraindicated in pediatric patients less than 2 years and should not be given to children under 18 years with acute diarrhea 2, 5
• Serious adverse effects including abdominal distention, ileus, drowsiness, and even deaths have been reported in children 1, 5
• The FDA label specifically warns against use in children for acute diarrhea 5

Do not use nonspecific antidiarrheal agents (kaolin-pectin, adsorbents) as they do not reduce diarrhea volume or duration and may cause harm 1

When to Consider Antibiotics (Not Applicable Here)

Antibiotics would only be considered if the patient developed: 1, 2

• Fever ≥38.5°C with signs of sepsis 2
• Bloody diarrhea suggesting Shigella or other invasive bacterial pathogens 1, 2
• Symptoms persisting beyond 7-10 days with documented bacterial pathogen on stool culture 1
• Clinical deterioration despite adequate hydration 1

Critical Pitfall to Avoid

If STEC (Shiga toxin-producing E. coli) is suspected or confirmed, antibiotics must be avoided as they increase the risk of hemolytic uremic syndrome. 1, 2, 6 However, this patient's presentation (watery diarrhea without blood, common-source outbreak) makes STEC unlikely.

Monitoring and Follow-Up

Instruct the parent to return or call if: 1

• Patient becomes lethargic or irritable 1
• Decreased urine output (sign of dehydration) 1
• Intractable vomiting preventing oral intake 1
• Bloody stools develop 1
• High fever develops (≥38.5°C) 2
• Diarrhea persists beyond 10-14 days 1

Infection Control

Emphasize handwashing after using the toilet and before food preparation to prevent transmission to other household members. 2