Gastroenteritis 4: Antibiotic Use

Antibiotics are not routine but are indicated in:

1. Suspected sepsis 

• Ampicillin and gentamicin if meningitis excluded/not suspected
• Ceftriaxone (100mg/kg/dose daily) if <3 months and meningitis cannot be excluded (e.g child too unwell to perform a lumbar puncture when indicated) 
  or 
  a child with renal impairment 
  or 
  unwell child with dysentery(50mg/kg/dose)
• Cefotaxime and Ampicillin if ≤1 month and meningitis cannot be excluded (e.g child too unwell to perform a lumbar puncture) or has renal impairment

2. Blood in stool (see protocol here)

3. Pneumonia (ampicillin or amoxycillin, add gentamicin if <6 months or if severely immune suppressed)

4. Severe Acute Malnutrition (see SAM protocol)

5. UTI (see antibiotic guidelines)

6. Otitis media (see antibiotic guidelines)

7. In certain children with HIV infection (see protocols/discuss with Reg/consultant)

8. In persistent diarrhoea (> 7 days) children consider using Metronidazole 500mg daily po for 5 days for giardiasis in the child over 6 months of age with persistent diarrhoea. If the child is being discharged remember that such children will require close follow up in terms of weight

This guidance is in part taken from:
WC Gastroenteritis Fam Med & Paeds Protocol 2014 
&
New Somerset Hosp Paeds Gastro Protocol 2014