CHAPTER 1: INTRODUCTION

1.1

Background of study

1.1.1 Overview

Acute gastroenteritis (AGE) is defined as diarrheal disease of rapid onset, with or

without associated symptoms or signs such as nausea, vomiting, fever or abdominal
pain (Practice Parameter, 1996). AGE is one of the common illnesses amongst
children, accounting for 16% of childhood emergency department presentations (Armon
K et al, 2001). Admission rate for AGE has increased significantly during the past
decade, and estimated that each year, approximately 2 million children younger than 5
years of age dies of AGE (Harlem G, 1999). At present, there is no detailed
epidemiological study on the burden of AGE in children from Malaysia. However, it was
estimated that 1.3% of all medically certified and uncertified deaths (or 69 deaths per
year) among children younger than 5 years of age were due to AGE (Hsu VP et al,
2005).
The most common cause of AGE, both in developed and developing countries is
still rotavirus with no specific antimicrobial agents for viral gastroenteritis (Pickering LK,
1983).

In the other hand, the common cause bacterial enteric pathogens such as

Escherichia coli, Salmonella and Shigella spp. are found in developing countries
whereas Campylobacter and Salmonella spp. in developed countries (Gastanaduy AS,
1999).
Most cases of acute gastroenteritis in children are viral, self-limited, and need
only supportive treatment. Appropriate fluid and electrolyte therapy, with close attention
to nutrition, remain central to therapy. Antibacterial therapy serves as an adjunct, to
shorten the clinical course, eradicate causative organisms, reduce transmission, and
prevent invasive complications. Selection of antibacterials to use in acute bacterial
gastroenteritis is based on clinical diagnosis of the likely pathogen prior to definitive

laboratory results. Antibacterial therapy should be restricted to specific bacterial

pathogens and disease presentations. In general, infections with Shigella spp. and
Vibrio cholera should usually be treated with antibacterials, while antibacterials are only
used in severe unresponsive infections with Salmonella, Yersinia, Aeromonas,
Campylobacter,Plesiomonas spp., and Clostridium difficile. Antibacterials should be
avoided in enterohemorrhagic Escherichia coli infection. However, empiric therapy may
be appropriate in the presence of a severe illness with bloody diarrhea and stool
leucocytes, particularly in infancy and the immunocompromised (Phavichitr N, 2003).
The main aim for this study is to describe the current practice of antibiotics use in
AGE in general pediatric ward. Clinical outcome and therapies are best understood by
classifying acute bacterial gastroenteritis. Hence the objectives of the study focus on the
characteristic of AGE patients, outcome of antibiotic use, review of isolated stool culture
and blood culture and pre-admission management of AGE.
1.2

Objectives
The objectives of the study include the following:
1. To describe the characteristics of acute gastroenteritis patient treated with
antibiotic or other medications other than rehydration therapy.
2. To evaluate patients outcome in relation to the use of antibiotic :
3. To describe the pathogen from stool culture and blood culture taken in ward.
4. To describe the empirical antibiotics spectrum in relation to the pathogen
isolated.
5. To describe the pre-admission management of pediatric that is diagnosed with

acute gastroenteritis.

1.3

Problem statement
Pediatric AGE remains an important clinical illness commonly encountered by

physician with associated complications such as vomiting, diarrhea and dehydration

continue to pose significant risk to children and health care expenditure.
The use of antibacterial therapy serves as an adjunct, to shorten the clinical
course, eradicate causative organisms, reduce transmission, and prevent invasive
complications. Therefore, the selection of antibacterials in acute bacterial gastroenteritis
is based on clinical diagnosis of the likely pathogen prior to definitive laboratory results.
Antibacterial therapy should be restricted to specific bacterial pathogens and disease
presentations. Hence, the benefits and risks of adverse drug reactions should be
weighed before prescribing antibacterials with the major concern antibacterial-resistant
strains emergence due to widespread use of antibacterial agents.

REFERENCES:
1. American Academy of Pediatrics. Practice parameter: the management of acute
gastroenteritis in young children. Pediatrics. 1996;97:424-35
2. Armon K, Stephenson T, MacFaul R, et al. An evidence and consensus based
guideline for acute diarrhoea management. Arch Dis Child 2001; 85: 132-42
3. Harlem G. WHO report on infectious disease: removing the obstacle to healthy
development. Brunotland: World Health Organization, 1999
4. Hsu VP, Abdul Rahman H, Wong SL, et al. Estimates of the burden of rotavirus
disease in Malaysia. J Infect Dis 2005;192(Suppl. 1):S806.
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North Am 1983; 30 (2): 373-85
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7. Phavichitr N, Catto-Smith A. Acute gastroenteritis in children: what role for

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