Pediatric Infectious Diarrhea: Stool Testing, Antibiotics and Child Care

About this tool

This tool helps a clinician decide two things for a child with diarrhea: whether a stool test is needed, and whether a positive result should be treated. It starts with red flags such as ill appearance, blood in the stool, young age, immunocompromise, recent antibiotics, travel, and outbreaks, and points well children with watery diarrhea away from testing and antibiotics.

Once a pathogen is known, each organism has its own plan. Shiga toxin-producing E. coli gets no antibiotics and close HUS monitoring. Shigella gets azithromycin or ceftriaxone by severity and susceptibility. Salmonella is treated only in high-risk hosts or invasive disease. Campylobacter, C. difficile, Giardia, Cryptosporidium, Yersinia and cholera each have mg/kg doses with maximums, calculated when a weight is entered.

Every result includes isolation and return-to-child-care rules, such as negative stool cultures for STEC as required by the health department, and links fluid management to the Dehydration and Vomiting and diarrhea tools.

Common questions

Should a child with E. coli O157 get antibiotics?

No. Antibiotics and antimotility drugs may increase the risk of hemolytic uremic syndrome. Give fluids, avoid NSAIDs, and check CBC, platelets and creatinine every 1–2 days while diarrhea continues.

When should a child with Salmonella diarrhea be treated?

Only if under 3 months, immunocompromised, with sickle cell disease or another hemoglobinopathy, chronic GI disease, or invasive infection such as bacteremia. Healthy older children are not treated because antibiotics do not shorten illness and can prolong carriage.

Should infants be tested for C. difficile?

Not under 12 months, because many healthy infants carry the organism and toxin. From 12 months to 2 years, test only after other causes are excluded. From 2 years, test for prolonged diarrhea with risk factors such as recent antibiotics.

When can a child with diarrhea return to child care?

When stools are contained in the diaper or toilet. STEC, Shigella and typhoid have extra rules set by the health department, often negative stool cultures before return.

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