Pediatric Guidelines: Gastrointestinal Infections - Bacterial Gastroenteritis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Bacterial gastroenteritis, community-onset

Characterized by frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping

Escherichia coli

Salmonella species

Shigella species

Campylobacter jejuni

Yersinia enterocolitica

Supportive care is the primary therapy for most patients

Antibiotics can predispose to complications such as hemolytic uremic syndrome with Shiga-toxin producing E. coli infection


Stool bacterial culture should be sent, also consider testing for Clostridium difficile if patient has recent hospital or antibiotic exposure. Blood cultures should be sent for patients who are hospitalized and/or toxic-appearing with suspected bacterial gastroenteritis. 

Directed therapy may be indicated early in the course for specific pathogens (such as CampylobacterShigella) but in most cases should be deferred until a positive stool culture result is obtained

Consider empiric therapy for toxic-appearing patient, young infant, or immunocompromised host:

Azithromycin 10mg/kg/dose PO daily (max 500mg/dose)


Ceftriaxone 50mg/kg IV q24h (max 1g/dose)

For traveler's diarrhea (enterotoxigenic E. coli):

Azithromycin 10mg/kg/dose PO daily x 3 days (max 500mg/dose) - provide un-reconstituted powder for suspension to infants and children traveling in high-risk areas


Guerrant, RL, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001:32;331-351.

CDC Yellow Book 2016. Traveler's Diarrhea.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).