Diarrhea (peds)
Causes
| Infection |
| Viral: rotavirus, Norwalk virus, enteroviruses, astroviruses, adenoviruses, caliciviruses |
| Bacterial: Salmonella, Shigella, Yersinia, Campylobacter, Escherichia coli, Aeromonas hydrophila, Vibrio species, Clostridium difficile, tuberculosis |
| Parasitic: Giardia lamblia, Entamoeba histolytica, Cryptosporidia |
| Dietary disturbances |
| Overfeeding, food allergy, starvation stools |
| Anatomic abnormalities |
| Intussusception, Hirschsprung disease, partial obstruction, appendicitis, blind loop syndrome, intestinal lymphangiectasia, short bowel syndrome |
| Inflammatory bowel disease |
| Malabsorption or secretory diseases |
| Cystic fibrosis, celiac disease, disaccharidase deficiency, acrodermatitis enteropathica, secretory neoplasms |
| Systemic diseases |
| Immunodeficiency, endocrinopathy (hyperthyroidism, hypoparathyroidism, congenital adrenal hyperplasia) |
| Miscellaneous |
| Antibiotic-associated diarrhea, secondary lactase deficiency, irritable colon syndrome, neonatal drug withdrawal, toxins, hemolytic uremic syndrome |
Treatment
Diarrheal Pathogens in Children and Specific Therapy
| AGENT | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE |
|---|---|
| Campylobacter jejuni | Azithromycin 12 mg/kg/day PO for 5 days or |
| Erythromycin 30–50 mg/kg/day, divided, tid PO for 5–7 days | |
| Clostridium difficile | Metronidazole 30 mg/kg/day, divided, qid PO for 7–10 days or |
| Escherichia coli | Azithromycin 12 mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day PO divided bid for 5–7 days | |
| Giardia lamblia | Metronidazole 15 mg/kg/day PO, divided, tid for 5 days |
| Salmonella species | In toxic infants <3 mo: Ampicillin 200 mg/kg/24 hours q6h for 7–10 days and Gentamicin 5–7.5 mg/kg/24 hours q8h IV |
| Shigella species | Azithromycin 12 mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day, divided, bid for 5–7 days if susceptible | |
| Yersinia enterocolitica | If patient is immunosuppressed, treat as for presumed sepsis |
| Vibrio | None; severe diarrhea or cholera may benefit from antibiotics |
See Also
Peds: Dehydration
Sources
Rosen's