- When antibiotics may be indicated (Shigella species · Campylobacter jejuni · enterotoxigenic E. coli · Vibrio cholerae · Yersinia enterocolitica · Entamoeba histolytica)
- Clinical context (Most acute gastroenteritis in children is viral — antibiotics not indicated · bacterial cause more likely with bloody stools, fever, or identified pathogen)
First-line therapy
Oral rehydration solution (ORS) • p.o.
Duration: Until rehydrated · Low-osmolarity ORS first-line · continue feeding · rest · paracetamol for fever — no routine antibiotics
Ceftriaxone • i.v. • 50–75 mg/kg/day • 1×/day
Max 2000 mg/day · Duration: 3–5 days · Severe dysentery, sepsis, infants <3 months, or parenteral therapy required
- • Ceftriaxone: severe illness, sepsis, inability to tolerate oral therapy, infants <3 months with bacterial indication, or hospitalized dysentery — WHO second-line for severe dysentery when local sensitivity unknown.
- • Ciprofloxacin: dysentery/Shigella when susceptible per culture or local epidemiology (WHO first-line for bloody diarrhea in endemic settings); azithromycin resistance or treatment failure — off-label in children; max 30 mg/kg/day (15 mg/kg/dose ×2).
- • Do not treat uncomplicated Salmonella gastroenteritis in otherwise healthy children (ESPID/ESPGHAN) — treat only high-risk or invasive disease.
- • Campylobacter: antibiotics only if started within 48 h of symptom onset (ESPGHAN); azithromycin preferred.
- • Avoid anti-motility agents (e.g. loperamide) in bloody diarrhea or suspected Shigella (CDC/NICE).
Enter weight on Kids to calculate doses
Clinical notes
- • Routine antibiotics are not recommended for most acute gastroenteritis — viral etiology is most common; management is rehydration and supportive care (ESPGHAN/NASPGHAN, AAP, NICE, WHO).
- • Antibiotic indications: infants <3 months; immunocompromised or chronic conditions (e.g. sickle cell); confirmed or strongly suspected Shigella, ETEC, V. cholerae, Yersinia, E. histolytica; early Campylobacter colitis (<48 h); severe or invasive bacterial disease (ESPGHAN Rec. 22–23, WHO, CDC).
- • Oral rehydration with low-osmolarity ORS is first-line for all children with dehydration — continue age-appropriate feeding; switch from i.v. to ORS as soon as tolerated (ESPGHAN, WHO).
- • Hospital admission: severe dehydration or shock; persistent vomiting precluding ORS; altered consciousness; failed outpatient rehydration; infants <3 months with significant illness; suspected sepsis or toxic appearance (WHO, ESPGHAN).
- • Stool culture and antimicrobial susceptibility guide therapy when feasible; reassess at 48 h if no improvement — especially where resistance is common (CDC, WHO).
- • ESPGHAN / NASPGHAN — Universal recommendations for management of acute diarrhea (2018)
- • ESPGHAN / ESPID — Evidence-based guidelines for management of acute gastroenteritis (2014)
- • AAP Red Book — Diarrheal diseases and bacterial enteric infections (2024)
+ 4 more
- • NICE NG84 — Diarrhoea and vomiting caused by gastroenteritis in under 5s (2017)
- • WHO — The treatment of diarrhoea (IMCI / Pocket Book) (2022)
- • CDC — Shigella treatment and antimicrobial resistance (2024)
- • ESPID — Bacterial diarrheas and antibiotics (European recommendations) (2008)