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Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

antibiotic treatment should not routinely be given in salmonella gastroenteritis. However, there
are some individuals at increased risk of systemic sepsis. Young infants are at increased risk of
developing salmonella gastroenteritis, and those younger than 6 months are at increased risk of
systemic spread. Others likely to be at high risk of sepsis are those with immune deficiency states
including HIV/AIDS and malnourished infants and children. The GDG concluded that in such
cases antibiotic treatment should be recommended.
The efficacy of antibiotic therapy for patients with campylobacter spp. is somewhat uncertain.
One randomised controlled trial in which treatment with erythromycin began while culture
results were pending found that treatment was associated with a shortened mean duration of
diarrhoea. There was no evidence to suggest that antibiotic therapy was beneficial in those
whose treatment began after a positive culture was available. The GDG therefore concluded that
antibiotics should only be used where septicaemia is suspected.
There was no evidence that antibiotic therapy was beneficial in the treatment of yersinia enteritis.
The GDG considered that antibiotics should be reserved for those with suspected or confirmed
yersinia septicaemia.
The GDG was aware that there was evidence to support the efficacy of antibiotic therapy in
patients with dysenteric shigellosis in adults. One randomised controlled trial of antibiotic therapy
for bacterial gastroenteritis in children found that, although there was no benefit in relation to
diarrhoea, the duration of fever and the time to clearance of stool pathogens were reduced.
The GDG therefore concluded that those with dysenteric shigellosis should receive antibiotic
treatment.
The GDG was aware that antibiotic treatment was effective in adults with enterotoxigenic E. coli, a
very common cause of traveller’s diarrhoea. The effect of antibiotic treatment for enteropathogenic
and enteroinvasive E. coli is uncertain.
Two studies were available regarding antibiotic treatment for the protozoal pathogen
Cryptosporidium parvum. Both evaluated the broad-spectrum antibiotic nitazoxanide that
has activity against protozoa. Both reported some evidence of benefit, but these studies had
methodological limitations. Routine treatment of gastroenteritis due to cryptosporidium was
therefore not recommended.
Young children with E. coli O157:H7 appeared to have a risk of 10–15% of developing HUS.
There was evidence to suggest that those with a leucocytosis at presentation are at higher risk.
Vomiting, especially in children younger than 5 years, was also associated with an increased
likelihood of progression to HUS. There was some evidence that antibiotic treatment might have
been a risk factor for HUS, although this finding was not consistent between studies. It might be
that this reported observation can be explained by the administration of antibiotics to those with
more severe disease. Nevertheless, the GDG considered that there was insufficient evidence to
recommend antibiotic treatment for E. coli O157:H7.
The GDG recognised that a number of other potential enteric pathogens exist that could cause
gastroenteritis, but there were no available clinical trials on treatment in children. Clostridium
difficile-associated pseudomembranous colitis is normally treated with antibiotics. The same is
true of Vibrio cholerae. Protozoal infections – including Isospora belli, Cyclospora cayetanensis,
Entamoeba histolytica and Giardia lamblia might all respond to antibiotic therapy, based on
studies in adults.
There was no clinic trial evidence on the treatment of traveller’s diarrhoea in children, but the
GDG considered that trials in adult patients were relevant, and these showed evidence of benefit
from antibiotic treatment. It was therefore agreed that in such cases consideration should be
given to seeking specialist advice regarding antibiotic treatment in children presenting with acute
diarrhoea shortly after return from overseas travel.

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