Prescribing antibiotics in diarrhoea

A recent study assessed the association between nutritional and clinical characteristics and quantitative PCR (qPCR)-diagnosis of bacterial diarrhea in a multicentre cohort of children under two years of age with moderate to severe diarrhea (MSD).

It enrolled 6692 Children with MSD [described as >3 loose stools in 24 hours and exhibiting at least one of the following: some/severe dehydration, moderate acute malnutrition (MAM), or severe stunting] and found

• Among 6692 children with MSD undergoing qPCR, 28% had likely bacterial diarrhea etiology. 
• Compared with children with severe stunting, children with MAM, some/severe dehydration, or both had higher odds of having possible bacterial diarrhea etiology. 
• Stable toxin-enterotoxigenic Escherichia coli etiology also showed Similar trends.
• Clinical correlates (like fever and chronic diarrhea) were not associated with likely bacterial etiology.
• Children who had more than six stools in the previous 24 hours had higher odds of likely bacterial diarrhea than those with fewer stools.
• This study offers valuable insights into managing pediatric diarrhea by demonstrating that the presence of MAM, dehydration, or high stool frequency can help identify children with MSD who might benefit from antibiotics.

Somji S, Ashorn P, Manji K, et al. Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial. BMJ Paediatr Open. 2024 Apr 11;8(1):e002448. doi: 10.1136/bmjpo-2023-002448. PMID: 38604769; PMCID: PMC11015214.