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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

Yersinia. 5. review of isolated stool culture and blood culture and pre-admission management of AGE.. and Vibrio cholera should usually be treated with antibacterials. Antibacterials should be avoided in enterohemorrhagic Escherichia coli infection. To describe the characteristics of acute gastroenteritis patient treated with antibiotic or other medications other than rehydration therapy. The main aim for this study is to describe the current practice of antibiotics use in AGE in general pediatric ward. . and Clostridium difficile. However. empiric therapy may be appropriate in the presence of a severe illness with bloody diarrhea and stool leucocytes. 1. Aeromonas.Plesiomonas spp. Clinical outcome and therapies are best understood by classifying acute bacterial gastroenteritis.2 Objectives The objectives of the study include the following: 1. Hence the objectives of the study focus on the characteristic of AGE patients. To describe the empirical antibiotics spectrum in relation to the pathogen isolated. particularly in infancy and the immunocompromised (Phavichitr N. outcome of antibiotic use. 2003). 4. In general.laboratory results. while antibacterials are only used in severe unresponsive infections with Salmonella. Campylobacter. Antibacterial therapy should be restricted to specific bacterial pathogens and disease presentations. To describe the pre-admission management of pediatric that is diagnosed with acute gastroenteritis. 2. To evaluate patient’s outcome in relation to the use of antibiotic : 3. infections with Shigella spp. To describe the pathogen from stool culture and blood culture taken in ward.

et al. and prevent invasive complications. Hence. to shorten the clinical course. 1):S80–6. et al. Pediatrics. the selection of antibacterials in acute bacterial gastroenteritis is based on clinical diagnosis of the likely pathogen prior to definitive laboratory results. Acute gastroenteritis. Brunotland: World Health Organization. eradicate causative organisms. An evidence and consensus based guideline for acute diarrhoea management. Estimates of the burden of rotavirus disease in Malaysia. Gastanaduy AS. Therefore. 1999 4. American Academy of Pediatrics. Hsu VP. The use of antibacterial therapy serves as an adjunct. Stephenson T. Wong SL. Abdul Rahman H. Antibacterial therapy should be restricted to specific bacterial pathogens and disease presentations. Practice parameter: the management of acute gastroenteritis in young children. Harlem G. reduce transmission. diarrhea and dehydration continue to pose significant risk to children and health care expenditure. Antimicrobial therapy of gastrointestinal infections. WHO report on infectious disease: removing the obstacle to healthy development.97:424-35 2. Clin Pediatr 1999. REFERENCES: 1.1. Arch Dis Child 2001. Begue RE. Pediatr Clin North Am 1983. Pickering LK. 30 (2): 373-85 6.192(Suppl. 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. Armon K. 38: 1-12 . MacFaul R.3 Problem statement Pediatric AGE remains an important clinical illness commonly encountered by physician with associated complications such as vomiting. 1996. 5. J Infect Dis 2005. 85: 132-42 3.

Catto-Smith A. Acute gastroenteritis in children: what role for antibacterials? Paediatr Drugs.7. 2003. Phavichitr N.5:279–290 .