Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach

To compare age and protein-energy malnutrition (PEM) - the predispositions - and fever and abnormal leukocyte count (ALC) - the SIRS criteria - in hospitalized children with and without diarrhea.

A prospective case-control study.

A pediatric ward of a general hospital in a low-resource setting.

Totally, 445 consecutive admissions to the pediatric ward of a general hospital over a period of 1 year were included in this prospective case-control study; hemodynamically unstable subjects (11) were excluded.

Age, PEM, fever, and ALC were assessed in 59 patients with diarrhea and compared with 375 control patients without diarrhea. Odds ratios with confidence intervals were determined; the chi-square test and binary logistic regression analysis were also performed.

Associations of diarrhea with age, PEM, fever and ALC singly and various combinations of predispositions and SIRS parameters.

Infancy and ALC were significantly associated with diarrhea. PEM or fever alone was not significantly associated with diarrhea; however, the probability of developing diarrhea was significantly higher when a combination of ALC and PEM was observed. The combination of infancy, PEM, and ALC carried a sensitivity of 81·36%; for other combinations, sensitivity varied between 70% and 80%. The combination of infancy and ALC had the lowest sensitivity (59·32%) but the best specificity (61·07%).

The association/presence of a combination of SIRS parameters (fever and ALC) and predispositions (infancy and PEM) in children with diarrhea may help in deciding whether antibiotic therapy should be initiated.