Management of acute infectious diarrhea for children living in resource-limited settings.

Acute infectious gastroenteritis continues to be a leading cause of morbidity and mortality in children below 5 years of age, with the majority of deaths concentrated in 35 'low income' countries. In these countries the under five years of age mortality rates reach 100 per 1000 live births, of which a significant proportion are associated with acute diarrhea. Rotavirus, cryptosporidium, Shigella spp and enterotoxigenic Escherichia coli are the main pathogens causing disease in these settings, although other bacteria and parasites can cause moderate to severe disease in different regions and situations. Treatment of children in these setting should be focused on appropriate rehydration, early hospitalization of severely malnourished children, zinc supplementation, and in specific situations, antimicrobials should be considered. The rationale for antimicrobial use should be based on the potential benefits based on published literature and the opportunity for use. This review provides a pathogen-specific update on the potential benefits of antimicrobials and suggests an empirical management approach for children suffering an acute watery or bloody diarrhea in a resource-limited region.

Serious bacterial infections in hospitalized febrile infants aged 90 days or younger: the traditional combination of ampicillin and gentamicin is still appropriate.

BACKGROUND: A change in the bacterial epidemiology of infantile serious bacterial infection (SBI) has raised concerns regarding the appropriate empirical antibiotic therapy. OBJECTIVE: To describe the epidemiological features of SBI in febrile infants in order to elucidate the appropriate empirical regimens. METHODS: From 2005 to 2009, clinical and laboratory data were prospectively collected for all infants aged ≤ 90 days who were hospitalized for fever. RESULTS: Of the 1584 febrile infants who met the study criteria, 149 (9.4%) had a culture-proven SBI: urinary tract infection in 128 (86%), urinary tract infection with bacteraemia in 11 (7%), bacteraemia in 7 (5%), enteritis with bacteraemia in 2 (1.3%), and meningitis in 1 (0.7%). Ninety-one percent of cases were caused by Gram-negative bacteria, mostly Escherichia coli (72%). Among the causative Gram-positive bacteria were Enterococcus spp. (4%) and group B Streptococcus (0.7%); no cases of Listeria monocytogenes infection were identified. Sixty-one percent of the causative bacteria were resistant to ampicillin. According to in vitro susceptibility testing, the combination of ampicillin and gentamicin provided appropriate antibiotic coverage. CONCLUSIONS: Despite changes in the epidemiology of infantile SBI, the traditional combination of ampicillin and gentamicin is still appropriate for empirical treatment of febrile infants aged ≤ 90 days.