Management of acute infectious diarrhea for children living in resource-limited settings

Expert Rev Anti Infect Ther. 2014 May;12(5):621-32. doi: 10.1586/14787210.2014.901168. Epub 2014 Mar 24.


Acute infectious gastroenteritis continues to be a leading cause of morbidity and mortality in children below 5 years of age, with the majority of deaths concentrated in 35 'low income' countries. In these countries the under five years of age mortality rates reach 100 per 1000 live births, of which a significant proportion are associated with acute diarrhea. Rotavirus, cryptosporidium, Shigella spp and enterotoxigenic Escherichia coli are the main pathogens causing disease in these settings, although other bacteria and parasites can cause moderate to severe disease in different regions and situations. Treatment of children in these setting should be focused on appropriate rehydration, early hospitalization of severely malnourished children, zinc supplementation, and in specific situations, antimicrobials should be considered. The rationale for antimicrobial use should be based on the potential benefits based on published literature and the opportunity for use. This review provides a pathogen-specific update on the potential benefits of antimicrobials and suggests an empirical management approach for children suffering an acute watery or bloody diarrhea in a resource-limited region.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Anti-Infective Agents / therapeutic use*
  • Child, Preschool
  • Cryptosporidiosis / parasitology
  • Cryptosporidiosis / therapy*
  • Developing Countries
  • Diarrhea / microbiology
  • Diarrhea / parasitology
  • Diarrhea / therapy*
  • Diarrhea / virology
  • Disease Management
  • Dysentery, Bacillary / microbiology
  • Dysentery, Bacillary / therapy*
  • Escherichia coli Infections / microbiology
  • Escherichia coli Infections / therapy*
  • Fluid Therapy
  • Hospitalization
  • Humans
  • Poverty Areas
  • Rotavirus Infections / therapy*
  • Rotavirus Infections / virology


  • Anti-Infective Agents