Overview

• Infectious diarrhoea: abx not usually indicated. Clarithro for 5-7 days if systemically unwell & campylobacter suspected. Tinidazole 2g STAT for suspected/confirmed giardia

• Diarrhoea (NHS Choices), Dysentery (NHS Choices), Flatulence (NHS Choices), Diarrhoea and vomiting - gastroenteritis (NHS Choices). Travellers diarrhoea: see Travel

Adults

• Diarrhoea - adult's assessment (CKS), Gastroenteritis in Adults and Older Children (patient.info)​

Children

Rotavirus is the most common viral cause of gastroenteritis in children, especially in children between the ages of 6 months and 2 years. It is transmitted via the faecal-oral route and contact with contaminated surfaces. Outbreaks in nurseries used to be common but have significantly reduced since the introduction of the oral rotavirus vaccine as part of the childhood immunization program in 2014.

Question

A six-month-old girl is breastfed and started taking solids about a month ago. She has had diarrhoea for the past 24 hours and has vomited once but appears hungry and willing to feed. She is well, apyrexial and has no signs of clinical dehydration.

Which is the SINGLE MOST appropriate advice? 

1. Continue breastfeeding as well as using oral rehydration solution

2. Replace breast milk with boiled water

3. Replace breast milk with full strength formula milk

4. Replace breast milk with half strength formula milk

5. Stop breastfeeding and use oral rehydration solution

National Institute for Health and Care Excellence (NICE) recommends in children presenting with gastroenteritis but without clinical signs of dehydration, the parents should be advised to maintain and encourage fluid intake. This would be in infants to continue to breastfed or other milk formula feeds. Oral rehydration solution can be added as supplemental fluid to infants and children at increased risk of dehydration.

Resource:

NICE. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. CG84. 2009.

Child with bloody diarrhoea: refer

• Gastroenteritis - child and adult (CKS), Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management (NICE, 2009), Gastroenteritis in Children (patient.info)

Antibiotic-associated diarrhoea

• Clostridium difficile: metronidazole, vancomycin, fidaxomicin

• Diarrhoea - antibiotic associated (CKS)