Prescribing Antibiotics in Pediatric Diarrhea

A recent multicenter study examined the relationship between nutritional and clinical characteristics and qPCR-confirmed bacterial diarrhea in children under two years with moderate to severe diarrhea (MSD). The study enrolled 6,692 children with MSD, defined as >3 loose stools in 24 hours plus at least one of: some/severe dehydration, moderate acute malnutrition (MAM), or severe stunting.

Key findings:

• 28% of children with MSD had a likely bacterial etiology by qPCR.
• Children with MAM, dehydration, or both had higher odds of bacterial diarrhea compared with those with severe stunting.
• Similar trends were observed for stable toxin–enterotoxigenic Escherichia coli (ETEC).
• Traditional clinical correlates, such as fever or chronic diarrhea, were not predictive of bacterial etiology.
• Children with >6 stools in the previous 24 hours had higher odds of bacterial diarrhea than those with fewer stools.

Implication: Nutritional status (MAM), dehydration, and high stool frequency can help identify children with MSD who may benefit from antibiotics, aiding targeted therapy in pediatric diarrhea.

Reference:

Somji S, Ashorn P, Manji K, et al. Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial. BMJ Paediatr Open. 2024 Apr 11;8(1):e002448. doi: 10.1136/bmjpo-2023-002448. PMID: 38604769; PMCID: PMC11015214.