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 Shiga toxin-producing Escherichia coli (STEC) 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 Clostridium difficile-associated pseudomembranous enterocolitis, giardiasis, dysenteric shigellosis, dysenteric amoebiasis or cholera.
  • Infants younger than 6 months, malnourished or immunocompromised with salmonella gastroenteritis
  • 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]