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

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, IndiaCorrespondence: Subhashchandra DagaDepartment of Pediatrics, Pacific Medical College, U...

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Main Authors: Daga S, Daga A, Mhatre S
Format: Article
Language:English
Published: Dove Medical Press 2020-03-01
Series:Pediatric Health, Medicine and Therapeutics
Subjects:
Online Access:https://www.dovepress.com/antibiotic-therapy-for-children-with-diarrhea-in-a-low-resource-settin-peer-reviewed-article-PHMT
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author Daga S
Daga A
Mhatre S
author_facet Daga S
Daga A
Mhatre S
author_sort Daga S
collection DOAJ
description 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, IndiaCorrespondence: Subhashchandra DagaDepartment of Pediatrics, Pacific Medical College, Udaipur 313001, IndiaTel +91 9960522259Email dagasubhash49@gmail.comObjective: 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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spelling doaj.art-69cf760dae2c4dfe9f93556c6eb73a532022-12-22T01:12:08ZengDove Medical PressPediatric Health, Medicine and Therapeutics1179-99272020-03-01Volume 119510052418Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic ApproachDaga SDaga AMhatre SSubhashchandra 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, IndiaCorrespondence: Subhashchandra DagaDepartment of Pediatrics, Pacific Medical College, Udaipur 313001, IndiaTel +91 9960522259Email dagasubhash49@gmail.comObjective: 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 mortalityhttps://www.dovepress.com/antibiotic-therapy-for-children-with-diarrhea-in-a-low-resource-settin-peer-reviewed-article-PHMTdiarrhea in childrensepsis in childrensirs in diarrheachild mortality.
spellingShingle Daga S
Daga A
Mhatre S
Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
Pediatric Health, Medicine and Therapeutics
diarrhea in children
sepsis in children
sirs in diarrhea
child mortality.
title Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
title_full Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
title_fullStr Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
title_full_unstemmed Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
title_short Antibiotic Therapy for Children with Diarrhea in a Low-Resource Setting: A Syndromic Approach
title_sort antibiotic therapy for children with diarrhea in a low resource setting a syndromic approach
topic diarrhea in children
sepsis in children
sirs in diarrhea
child mortality.
url https://www.dovepress.com/antibiotic-therapy-for-children-with-diarrhea-in-a-low-resource-settin-peer-reviewed-article-PHMT
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