National Consensus for the Management of Acute Gastroenteritis in Jordanian Children: Consensus Recommendations Endorsed by the Jordanian Paediatric Society

Table 2

Antimicrobial therapy for infective gastroenteritis.

Pathogen	Indication for antibiotic therapy	Drug of choice	Alternative agents
Shigella spp.	Proven or suspected shigellosis	Oral: azithromycin (12 mg/kg on day 1, followed by 6 mg/kg for 4 days); parenteral, IV, IM: ceftriaxone (50–mg/kg for 2-5 days)	Cefixime (8 mg/kg per day); ciprofloxacin^z PO (20-30 mg/kg per day). For a known susceptible strain: TMP/SMX^y (8 mg/kg per day of TMP) or ampicillin (100 mg/kg per day) or nalidixic acid (55 mg/kg per day)
Salmonella spp. (nontyphoidal)	Antibiotic therapy is indicated only in high-risk children to reduce the risk of bacteraemia and extraintestinal focal infections	Ceftriaxone (50–100 mg/kg per day)	Azithromycin (10 mg/kg per day); ciprofloxacin^z PO (20-30 mg/kg per day); for a known susceptible strain, TMP/SMX (8 mg/kg day of TMP)
Campylobacter spp.	Antibiotic therapy is recommended mainly for the dysenteric Campylobacter gastroenteritis and most efficacious when started within 3 days after the onset of the disease	Azithromycin (10 mg/kg per day for 3 days or a single dose of 30 mg/kg)	Doxycycline (>8 years) or ciprofloxacin (>17 years), when susceptible
Shiga toxin-producing Escherichia coli	Antibiotic therapy is not recommended	—	—
Enterotoxigenic; Escherichia coli	Antibiotic therapy is recommended, mainly for a traveller’s diarrhoea	Azithromycin (10 mg/kg per day for 3 days)	Cefixime (8 mg/kg per day for 5 days); TMP/SMX (8 mg/kg per day of TMP); ciprofloxacin PO (20–30 mg/kg per day); rifaximin (>12 years, 600 mg/day, for 3 days)
Vibrio cholerae	Antibiotic therapy is recommended for confirmed or suspected case by travel history	Azithromycin (10 mg/kg per day for 3 days or a single 20 mg/kg dose)	Doxycycline (>8 years), ciprofloxacin (>17 years), or TMP/SMX (when susceptible)
Clostridium difficile	Antibiotic therapy is recommended for moderate and severe cases	Metronidazole (30 mg/kg per day for 10 days)	Vancomycin PO (40 mg/kg per day)

PO: per os (by mouth). depends on a local antibiotic susceptibility profile, which should be monitored. ^yTMP/SMX: trimethoprim-sulfamethoxazole. ^zCiprofloxacin is usually not recommended in the paediatric age group, but it can be used in when an alternative is not feasible. Table reprinted with permission from Guarino et al. [15]. Drug dosage is subject to change according to local regulations at the discretion of the treating physician. For more details, refer to the relevant section in Guarino et al.’s [15] guidelines.