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Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach

Authors Daga S, Daga A, Mhatre S

Received 21 October 2019

Accepted for publication 2 March 2020

Published 10 March 2020 Volume 2020:11 Pages 95—100


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Roosy Aulakh

Subhashchandra Daga,1 Achla Daga,2 Sameer Mhatre1

1Department of Pediatrics, MIMER Medical College, Talegaon Dabhade 410507, India; 2Department of Community Medicine, Pacific Medical College, Udaipur 313001, India

Correspondence: Subhashchandra Daga
Department of Pediatrics, Pacific Medical College, Udaipur 313001, India
Tel +91 9960522259

Objective: To compare age and protein-energy malnutrition (PEM) – the predispositions – and fever and abnormal leukocyte count (ALC) – the SIRS criteria – in hospitalized children with and without diarrhea.
Design: A prospective case-control study.
Setting: A pediatric ward of a general hospital in a low-resource setting.
Participants: Totally, 445 consecutive admissions to the pediatric ward of a general hospital over a period of 1 year were included in this prospective case-control study; hemodynamically unstable subjects (11) were excluded.
Interventions: Age, PEM, fever, and ALC were assessed in 59 patients with diarrhea and compared with 375 control patients without diarrhea. Odds ratios with confidence intervals were determined; the chi-square test and binary logistic regression analysis were also performed.
Main Outcome Measures: Associations of diarrhea with age, PEM, fever and ALC singly and various combinations of predispositions and SIRS parameters.
Results: Infancy and ALC were significantly associated with diarrhea. PEM or fever alone was not significantly associated with diarrhea; however, the probability of developing diarrhea was significantly higher when a combination of ALC and PEM was observed. The combination of infancy, PEM, and ALC carried a sensitivity of 81· 36%; for other combinations, sensitivity varied between 70% and 80%. The combination of infancy and ALC had the lowest sensitivity (59· 32%) but the best specificity (61· 07%).
Conclusion: The association/presence of a combination of SIRS parameters (fever and ALC) and predispositions (infancy and PEM) in children with diarrhea may help in deciding whether antibiotic therapy should be initiated.

Keywords: diarrhea in children, sepsis in children, SIRS in diarrhea, child mortality

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