Treatment

• Do not give antidiarrhoeals such as diphenoxylate, bismuth subsalicylate, loperamide etc.

• Do not routinely give antibiotics

• Give antibiotics to children:

  • With suspected or confirmed septicaemia
  • With extra-intestinal spread of bacterial infection
  • <6 months with salmonella gastroenteritis
  • Who are malnourished or immunocompromised with Salmonella gastroenteritis
  • With Clostridium difficile – associated pseudomembranous enterocolitis giardiasis, dysenteric shigellosis, dysenteric amoebiasis, or cholera and signs of severe dehydration or shock (if cholera is present in the area)

• Assess and treat dehydration as for other acute diarrhea

• Suspect cholera in children >2 years old who have acute watery diarrhoea (“rice water” stools) and signs of severe dehydration (if cholera is present in the area)

  • Give an oral antibiotic to which strains of V. cholerae in the area are known to be sensitive

• Young infants <2 years old with dysentery

• Severely ill children

• Lethargy, persistent vomiting, abdominal distension or tenderness

• Convulsions

• Other medical and surgical complications

• Treat as per general management of severely malnourished children

• Treat for Shigella first and then for amoebiasis on clinical grounds if laboratory examination is not possible

Such as:

• Surgical conditions (e.g. appendicitis, intussusception)

• Urinary tract infection

• Infection at other sites (including meningitis, sepsis)

• Haemolytic uremic syndrome (HUS)

Assess the child for signs of dehydration and give fluids according to MPS

Such as:

• No fever

• Less frequent stools with less blood

• Improved appetite

• Check for alternative/additional diagnoses

• Stop the first antibiotic

• Give the child a second-line antibiotic that is known to be effective against Shigella in the area