Management of acute infectious diarrhea for children living in resource-limited settings
Miguel O'Ryan G1, Liat Ashkenazi-Hoffnung, Miguel A O'Ryan-Soriano
1Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
Insights
Acute infectious gastroenteritis in young children is a major cause of death in low-income countries. This review updates antimicrobial benefits for treating diarrhea caused by specific pathogens.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Acute infectious gastroenteritis is a primary cause of mortality in children under five, particularly in low-income nations.
- Diarrheal diseases account for a substantial portion of under-five deaths in these regions.
- Key pathogens include Rotavirus, Cryptosporidium, Shigella spp., and enterotoxigenic Escherichia coli.
Purpose of the Study:
- To provide a pathogen-specific review of antimicrobial benefits for acute infectious gastroenteritis in children.
- To suggest an empirical management strategy for acute watery or bloody diarrhea in resource-limited settings.
Main Methods:
- Literature review focusing on antimicrobial efficacy against common gastroenteritis pathogens.
- Analysis of treatment guidelines and clinical evidence for managing childhood diarrhea.
Main Results:
- Identifies specific pathogens and their associated treatment considerations.
- Highlights the importance of rehydration, nutritional support, and judicious antimicrobial use.
- Discusses the rationale and evidence supporting antimicrobial interventions.
Conclusions:
- Effective management involves rehydration, nutritional support, and considering antimicrobials based on pathogen-specific evidence.
- An empirical approach to antimicrobial therapy can be beneficial in resource-limited settings.
- Further research on antimicrobial stewardship in pediatric gastroenteritis is warranted.
Abstract:
Acute infectious gastroenteritis continues to be a leading cause of morbidity and mortality in children below 5 years of age, with the majority of deaths concentrated in 35 'low income' countries. In these countries the under five years of age mortality rates reach 100 per 1000 live births, of which a significant proportion are associated with acute diarrhea. Rotavirus, cryptosporidium, Shigella spp and enterotoxigenic Escherichia coli are the main pathogens causing disease in these settings, although other bacteria and parasites can cause moderate to severe disease in different regions and situations. Treatment of children in these setting should be focused on appropriate rehydration, early hospitalization of severely malnourished children, zinc supplementation, and in specific situations, antimicrobials should be considered. The rationale for antimicrobial use should be based on the potential benefits based on published literature and the opportunity for use. This review provides a pathogen-specific update on the potential benefits of antimicrobials and suggests an empirical management approach for children suffering an acute watery or bloody diarrhea in a resource-limited region.
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