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

Area of Science:

• Pediatric infectious diseases
• Clinical microbiology
• Epidemiology

Background:

• Diarrhea is a common pediatric illness, particularly in low-resource settings.
• Identifying risk factors for diarrhea is crucial for timely and appropriate treatment.
• Protein-energy malnutrition (PEM) and Systemic Inflammatory Response Syndrome (SIRS) criteria like fever and abnormal leukocyte count (ALC) are potential contributors.

Purpose of the Study:

• To compare age and PEM (predispositions) with fever and ALC (SIRS criteria) in hospitalized children with and without diarrhea.
• To determine the association of these factors, individually and in combination, with the presence of diarrhea.
• To evaluate their utility in guiding antibiotic therapy decisions.

Main Methods:

• A prospective case-control study was conducted in a pediatric ward of a general hospital.
• 445 children were included, with 59 diagnosed with diarrhea and 375 controls.
• Age, PEM, fever, and ALC were assessed, and statistical analyses including logistic regression were performed.

Main Results:

• Infancy and ALC were significantly associated with diarrhea.
• PEM or fever alone did not show significant association, but their combination with ALC increased diarrhea probability.
• A combination of infancy, PEM, and ALC demonstrated high sensitivity (81.36%) for identifying diarrhea.

Conclusions:

• The presence of a combination of SIRS parameters (fever, ALC) and predispositions (infancy, PEM) in children with diarrhea can aid in deciding on antibiotic therapy.
• These factors, particularly in combination, are valuable indicators in pediatric diarrhea management.
• Further research could refine diagnostic criteria using these combined factors.