Antibiotic Treatment for Bacterial Gastroenteritis in Children

General Principles of Treatment

The American Academy of Pediatrics recommends that the routine use of broad-spectrum antibiotics is not indicated for all children with fever and abdominal pain when there is low suspicion of complicated intra-abdominal infection 1, 2

The Infectious Diseases Society of America recommends that children with severe salmonellosis or those at high risk should receive antibiotic treatment, with ceftriaxone as the first option, at a dose of 50-75 mg/kg/day every 12-24 hours 1, 2
The American Academy of Family Physicians suggests that ciprofloxacin can be used as an alternative, at a dose of 20-30 mg/kg/day every 12 hours, but should be avoided in children under 18 years old if alternatives are available 3

For shigellosis, azithromycin is the first option, with the dose to be determined by a pediatric dosing guide 1
For campylobacter infections, azithromycin is also the first option, with the dose to be determined by a pediatric dosing guide 1

For severe cases where empiric treatment is required before bacterial identification, a combination of ciprofloxacin and metronidazol can be used, at doses of 20-30 mg/kg/day every 12 hours and 30-40 mg/kg/day every 8 hours, respectively 1, 2, 4
Alternatively, a regimen based on aminoglycosides can be used 1, 2, 4

The American Family Physician recommends that fluoroquinolones should be avoided in children under 18 years old and pregnant women 3
The Infectious Diseases Society of America recommends that empiric treatment without bacteriological documentation should be avoided in most cases, and that antibiotic resistance in Salmonella, Shigella, and Campylobacter is a global concern that limits therapeutic options 1, 2