Additional Therapies

The following therapies have been suggested in the management of paediatric gastroenteritis:

Antibiotics

The majority of cases of paediatric gastroenteritis are viral and antibiotics are not required. Even cases of bacterial or protozoal infection are generally self-limiting [1].

Antibiotics should not be used for otherwise healthy children with Salmonella gastroenteritis as a carrier state may result [2].

Advice should be sought in cases of children with Escherichia coli O157:H7 infection regarding monitoring for haemolytic uraemic syndrome [1].

Antibiotics should only be given in cases of:

  • Suspected or confirmed septicaemia
  • Extra-intestinal spread of bacterial infection
  • Confirmed shigellosis, Vibrio Cholera, dysenteric Campylobacter or moderate-severe Clostridium difficile
  • Salmonella infection in infants or immunocompromised children only
  • Specialist advice should be sought in children who have recently returned from abroad

Anti-diarrheal agents

These are not recommended [1].

Probiotics

These are not recommended by NICE [1]. Subsequent reviews have suggested a potential role [16], with studies ongoing in this area.

Antiemetics

These are not explicitly recommended by NICE [1].

Subsequent evidence showed that a single oral dose of ondansetron helps to stop vomiting and reduce the number needing IV fluid and admission [17]. Its use is recommended by American guidelines [18].

Ondansetron is associated with increased frequency of diarrhoea, so is not recommended in children with moderate to severe diarrhoeal symptoms. There is also a risk of prolongation of the QT interval, especially in children with electrolyte abnormalities, so ECG monitoring is recommended [2].