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Acute gastroenteritis Usually viruses e.g. rotavirus |
Antibiotics not recommended |
Oral rehydration is the cornerstone of treatment. Antibiotic therapy may prolong carriage state of salmonellosis. |
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GASTROINTESTINAL TRACT INFECTIONS
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Infection/Condition and Likely Organism |
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Dysentery Shigella spp., Escherichia coli, Campylobacter |
Most are mild infections which resolve spontaneously without antibiotics |
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Mild or uncomplicated |
No treatment required |
Ampicillin 100mg/kg/day PO in 4 divided doses for 5-7 days for hospitalized children |
Amoxicillin, Trimethoprim-sulfamethoxazole, Ciprofloxacin and Azithromycin resistance are in the rise. Duration : 3 days. For immunocompromised : 7-10 days. Reserve fluoroquinolone only for isolate where there is no other antibiotic option. |
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Severe illness (hospitalisation, invasive or other complications) or immunocompromised patients |
Empiric: Ceftriaxone 50-75mg/kg/day IV q24h for 5 days |
Ciprofloxacin 20-30mg/kg/day IV in 2 divided doses for 3 days OR Azithromycin 10mg/kg/dose IV q24h (max. 500mg/dose) |
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Dysentery Amoebiasis |
Metronidazole 30-50mg/kg/day PO in 3 divided doses for 7-10 days |
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Similar dosage for extraintestinal disease. |
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Giardiasis |
Metronidazole 15mg/kg/day PO (max. 250mg) in 3 divided doses for 5-7 days |
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Hospital acquired diarrhea Clostridium difficile |
Metronidazole 30mg/kg/day PO in 4 divided doses for 10 days |
In severe diseases Vancomycin 40mg/kg/day PO in 4 divided doses for 10 days PLUS Metronidazole 30mg/kg/day PO in 4 divided doses for 10 days |
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Typhoid fever Salmonella Typhi Salmonella Paratyphi A and B |
Empirical treatment: Ceftriaxone 50-75mg/kg/day IV q24h (max. 2gm) for 7-14 days OR Azithromycin 20mg/kg/day (1g/day) for 7 days |
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Adjust antibiotic once C&S results are known. Duration of antibiotics: 7 days (uncomplicated) to 14 days (severe disease or if using Ampicillin or Trimethoprim-sulfamethoxazole). |
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Mild or uncomplicated |
Azithromycin 20mg/kg/day (1g/day) for 7 days OR Ciprofloxacin 20-40mg/kg/day (max. 1.5gm per day) PO in 2 divided doses for 5-7 days OR Cefixime 20mg/kg/day in 2 divided doses for 7 days |
Chloramphenicol 50-100mg/kg/day PO in 4 divided doses for minimum 14 days |
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Severe infection or suspected resistant organism |
Ceftriaxone 60-80mg/kg/day IV q24h for 7-14 days |
Ciprofloxacin 20-30mg/kg/day IV (max. 0.8-1.2gm/day) in 2 divided doses for 7-10 days |
Choice of antibiotics and duration depends on disease, C&S results and whether oral route is preferred. Fluoroquinolones need to be used with caution in children due to possible arthropathy and rapid development of resistance. Ampicillin and Trimethoprim-sulfamethoxazole may be considered for susceptible strain. |
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Chronic carrier state (> 1 year) |
Ampicillin 100mg/kg/day PO in 4 divided doses for 6 weeks OR Amoxicillin 100mg/kg/day PO in 2 divided doses for 6 weeks OR Trimethoprim-sulfamethoxazole 8mg (TMP)/kg/day PO in two divided doses for 6 weeks |
Ciprofloxacin 20-30mg/kg/day PO in 2 divided doses for 4 weeks. OR Ampicillin 200-300mg/kg/day IV maximum in 4-6 divided doses. (If oral therapy not tolerated and strain is susceptible) |
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Cholera Vibrio cholerae |
Azithromycin 20mg/kg/ day PO in a single dose (max. 1gm) OR Erythromycin ethylsuccinate 12.5mg/ kg/dose PO q6h for 3 days (max. 250mg/dose) (Watch group preferred due to lesser adverse effects) |
Doxycycline 4.4mg/kg/ day (max. 200mg/day) PO daily (children> 8 years old) OR Tetracycline 12.5mg/kg/ dose PO in q6h (max. 500mg/dose) for 3 days (children > 8 years old) |
Oral or IV rehydration is the cornerstone of treatment. Antimicrobials should be considered for moderately to severely ill. Avoid using Tetracycline or Doxycycline for young children. Use of Doxycycline should be considered in an epidemic caused by susceptible isolate. Fluoroquinolones - not approved for children < 18 years for this indication. |
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Liver abscess (amoebic) Entamoeba histolytica |
Metronidazole 35-50mg/ kg/day PO in 3 divided doses for 7-10 days |
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Amoebic abscess tends to be solitary lesion. Consider surgical drainage if needed. |
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Liver abscess (pyogenic). Klebsiella spp., Escherichia coli, Streptococcus, anginosus group, other Gram-negative organisms, anaerobes, Staphylococcus aureus |
Cefotaxime 200mg-300mg/kg/day IV in 4 divided doses (max. 2gm/ dose) OR Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day) PLUS Metronidazole 22.5-40mg/kg/day IV in 3 divided doses max. 4 mg/day |
Piperacillin-tazobactam 300mg/kg/day (of piperacillin component) IV in 3-4 divided doses (max. 16gm/day) ESBL-Klebsiella spp. Ertapenem 30mg/kg/day in 2 divided doses (max. 1gm/day) (above 3 months of age)* |
Surgical drainage is needed in most cases. Duration: 4-6 weeks *If available |
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Acute cholangitis Gram-positive and Gram-negative organisms, anaerobes |
Ampicillin-sulbactam 200-300mg/kg/day (of Ampicillin component) IV in 4-6 equally-divided doses |
Cefotaxime 200mg-300mg/kg IV in 4 divided doses (max. 2gm/dose) OR Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day) PLUS Metronidazole 22.5-40mg/kg/day IV in 3 divided doses (max. 4gm/day) OR Piperacillin-tazobactam 300mg/kg/day (of piperacillin component) in 3-4 divided doses IV (max. 16gm/day) |
Duration - 7 days. Outcome is similar with less than 7 days to those with longer duration >7 days in patients treated with percutaneous cholecystectomy. In treatment failure, need source control. |
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Peritonitis Gram-positive and Gram-negative organisms, anaerobes |
Primary/spontaneous bacterial peritonitis Cefotaxime 200mg -300mg/kg IV in 4 divided doses (max. 2gm/dose) Secondary (nosocomial) peritonitis Piperacillin-tazobactam IV 300mg/kg/day in 3- 4 divided doses (max. 16gm/day) |
Ampicillin 100mg/kg/day PO in 4 divided doses PLUS Gentamicin 5mg/kg/day IV q24h PLUS Metronidazole 7.5mg/kg/ dose IV 8h for 7-14 days |
May omit Metronidazole in primary peritonitis. In immunocompetent patient with mild to moderate peritonitis and source control, suggest 5 days of therapy. |
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If culture proven ESBL: Imipenem-cilastatin 60-100mg/kg/day IV in 4 divided doses Meropenem 60-100mg/kg/day IV in 3 divided doses |
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De-escalate treatment to Ertapenem 30mg/kg/day IV in 2 divided doses (max. 1gm/day) once patient is stable. |