Severe, Culture-directed
One or more of:
> 6 diarrheal episodes/day
bloody diarrhea
persistent (> 1 week) diarrhea
fever
Campylobacter spp
- Symptoms occur 1-10 days after exposure and usually resolve within 2-5 days.
No therapy unless severe, prolonged, or immunocompromised
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin | 10mg/kg PO daily | 3 days |
Shiga toxin-producing E. coli, including E. coli O157:H7
- Avoid antimotility agents.
Antibiotic therapy contraindicated
Salmonella typhi
Salmonella paratyphi
- Relapse rate 10% after antibiotic therapy.
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin |
20mg/kg PO day 1, then 10mg/kg PO daily |
7 days |
Hospitalized/Bacteremic
| Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 100mg/kg IV q24h | 7-10 days |
| If Salmonella acquired in Pakistan or Iraq and child is systemically unwell: | ||
| Meropenem | 60mg/kg/d IV div q6-8h | 7-10 days |
Salmonella spp, non typhoidal
Recommend blood culture if one or more of:
< 3 months old (also CSF culture)
febrile
immunocompromised.
No therapy for diarrhea unless high risk
High risk (base on susceptibility; if not known, use azithromycin)
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin |
20mg/kg PO day 1, then 10mg/kg PO daily |
7 days |
Hospitalized/bacteremic/<3 months old/immunocompromised
| Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 100mg/kg IV q24h | Consult pediatric infectious diseases |
Shigella spp
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin | 10mg/kg PO daily | 3 days |
| or | ||
| Ceftriaxone | 50mg/kg IV q24h |
Alternative
| Therapy | Dose | Duration |
|---|---|---|
| Cefixime | 8mg/kg/d PO div q12-24h |
Aeromonas spp
Plesiomonas spp
Vibrio spp, not V. cholerae
Yersinia spp
No therapy for diarrhea unless severe, prolonged or immunocompromised
| Therapy | Dose | Duration |
|---|---|---|
| TMP/SMX (if > 1 month old) | 8mg TMP/kg/d PO div bid | |
| or | ||
| Azithromycin | 10mg/kg PO daily |
Vibrio cholerae
- Fluid/rehydration essential.
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin | 20mg/kg PO once | 1 dose |