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 9-Year-Old with Acute Watery Diarrhea from Foodborne Illness

This child requires supportive care with oral rehydration and early refeeding only—no antibiotics are indicated. 1, 2

Immediate Management: Rehydration

Since the patient is tolerating oral fluids well and maintaining adequate hydration per mother's report, continue with oral rehydration solution (ORS) as the cornerstone of therapy. 1, 2

• Reduced osmolarity ORS is first-line therapy for mild to moderate dehydration in children with acute diarrhea from any cause (strong recommendation). 1, 2
• The patient should receive ORS to replace ongoing stool losses until diarrhea resolves completely. 1, 2
• If the child has any signs of dehydration despite oral intake, administer ORS in small, frequent volumes (e.g., 5 mL every minute initially) to correct the deficit. 1

Nutritional Management: Resume Normal Diet Immediately

Do not withhold food—this is a critical error that delays recovery. 1, 2

• Resume an age-appropriate usual diet immediately, even while diarrhea continues. 1, 2
• For a 9-year-old, recommended foods include starches, cereals, yogurt, fruits, and vegetables. 1
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice, Jell-O, presweetened cereals) as these can worsen diarrhea through osmotic effects. 1
• Avoid foods high in fat as they may delay gastric emptying and not be well tolerated. 1

Antibiotic Therapy: NOT Indicated

Empiric antimicrobial therapy is not recommended for this patient and should be avoided. 1, 2, 3

Here's why antibiotics are contraindicated in this case:

• The patient has acute watery diarrhea without recent international travel—this does not meet criteria for empiric antibiotics (strong recommendation). 1, 2
• The patient has no fever, no bloody stools, and no signs of sepsis—all of which would be required to consider antibiotics. 1, 2
• The patient is not immunocompromised and is older than 3 months—exceptions where empiric therapy might be considered. 2
• Viral gastroenteritis (most likely norovirus) is the predominant cause of acute watery diarrhea in children, especially in foodborne outbreaks affecting multiple family members. 1, 4
• Antibiotics can be harmful if this is STEC (Shiga toxin-producing E. coli), increasing the risk of hemolytic uremic syndrome. 1, 2, 3

When to Consider Antibiotics (None Apply Here)

Antibiotics should only be considered when: 1

• Dysentery (bloody diarrhea) is present
• High fever is documented
• Watery diarrhea persists for greater than 5 days (this patient is at 6-7 days but improving with last episode this morning)
• Stool cultures identify a specific pathogen requiring treatment
• The patient is immunocompromised

Since this patient's symptoms are resolving (last episode this morning, tolerating fluids well), the 6-7 day duration does not warrant empiric antibiotics. 1

Medications to Avoid

Do not use antimotility agents (loperamide, kaolin-pectin) in this 9-year-old child. 1, 2

• Antimotility drugs should not be given to children <18 years with acute diarrhea. 2
• These agents can cause severe complications including ileus, abdominal distention, and even death in children. 1
• They do not reduce stool water losses despite improving stool consistency and may increase electrolyte losses. 1

Monitoring and Follow-Up

Instruct the mother to return or call if the child develops: 1

• Irritability or lethargy
• Decreased urine output
• Intractable vomiting
• Worsening or persistent diarrhea beyond 2-3 more days
• Fever or bloody stools (new symptoms)

Infection Control

Emphasize proper handwashing techniques and hygiene practices to prevent transmission to other household members. 2

Common Pitfalls to Avoid

• Starting antibiotics empirically when rehydration alone is indicated—this is inappropriate and potentially harmful. 2, 3
• Withholding food during the diarrheal episode—early refeeding is essential for recovery. 2
• Using antimotility agents in children—these have serious side effects and no proven benefit. 1, 2
• Focusing on stopping diarrhea rather than maintaining hydration—diarrhea is the body's mechanism to clear the pathogen. 1