DIAGNOSIS AND TREATMENT: ANTIBIOTIC THERAPY OF INFECTIOUS DIARRHEA IN CHILDREN

THE PURPOSE of this review is to summarize the present status of antibiotic therapy of diarrhea in infancy and childhood. Such a review is currently pertinent because increased knowledge of the natural history of bacterial enteric diseases and the effects exerted by antibiotics on the course of these diseases enables the physician to approach such therapy on a more rational basis. Most diarrhea in infancy and childhood is not identifiable as bacterial in etiology. While in some communities 5% or less of such patients can be shown to harbor recognizable bacterial pathogens, as many as 60% of patients in other areas may yield bacterial pathogens on culture. The etiology of diarrhea in the absence of identifiable bacterial pathogens is obscure, although the results of a number of studies indicate that certain enteroviruses are frequently responsible. BACTERIOLOGIC STUDIES Of paramount importance in the management of patients with diarrhea is a careful search for bacterial pathogens because the decision as to whether to employ an antibiotic—and, if so, which antibiotic—is based upon the results of appropriate studies. Such studies comprise culture of the stool on specific media or examination by fluorescent antibody techniques. Serologic examinations are ordinarily unavailable for infections due to shigellae and EPEC, and they are of value in only a few salmonella infections; in addition, they do not afford prompt answers. The expense involved in such bacteriologic examinations is considerable and indicates the need for some selectivity in determining which patients should be studied for the presence of bacterial pathogens.