Patient selection: pediatric patient with nausea and vomiting associated with gastroenteritis
Recommendations:
(1) Do not use antidiarrheal agents.
(2) Do not routinely give antibiotics, reserving them for specific situations (see below).
(3) Consult with an infectious disease specialist when appropriate. The indication given is for foreign travel but there are others (immunosuppression, neutropenia, etc).
Indications for the use of antibiotics in a child with gastroenteritis:
(1) suspected or confirmed sepsis
(2) extra-intestinal extension/spread of the infecton
(3) Salmonella gastroenteritis AND one or more of the following:
(3a) age < 6 months
(3b) malnourishment
(3c) immunocompromised
(4) Clostridium difficile enterocolitis
(5) giardiasis
(6) dysentery due to Shigella species
(7) cholera
(8) fulminant amebic colitis (dysenteric amebiasis)
If it is decided to give antibiotic therapy then consider performing a blood culture prior to starting.
