Bruzzese Eugenia, Giannattasio Antonietta, Guarino Alfredo
Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, 80131, Italy.
F1000Res. 2018 Feb 15;7:193. doi: 10.12688/f1000research.12328.1. eCollection 2018.
Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler's diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.
抗生素治疗对儿童急性腹泻并非必要，因为补液是关键治疗措施，且症状通常无需特殊治疗即可缓解。通常无需查找肠胃炎的病因；然而，如果考虑进行抗菌治疗，则可能有必要查找病因。在没有明确指征的情况下，后者由医生评估决定。对于病情严重的儿童、患有慢性病或有特定危险因素的儿童或在特定情况下，应考虑进行抗菌治疗。旅行者腹泻、持续性腹泻和抗生素相关性腹泻也可能需要抗生素治疗。根据症状的严重程度或传播风险，可在等待微生物学检查结果时开始经验性治疗。抗生素的选择取决于可疑病原体、宿主状况和当地流行病学情况。在大多数情况下，应在等待结果时开始经验性治疗。经验性治疗可从口服复方磺胺甲恶唑或甲硝唑开始，但在严重病例中，可考虑用头孢曲松或环丙沙星进行胃肠外治疗。
