Rectal bleeding in early infancy: a warning sign of necrotizing enterocolitis that should not be overlooked in high-risk infants.
Refinessuggested applicable standard· Infectious Diseases Society of America (IDSA), '2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea,' 2017
Decision at staketriage of acute diarrhea or rectal bleeding in infants under 3 months
Triage acute diarrhea (<14 days) by duration and severity: most is viral, self-limited, and needs only supportive care with hydration and no testing. … When indicated, treat adults with a fluoroquinolone such as ciprofloxacin or with azithromycin, chosen by local susceptibility and travel history (strong, moderate); infants <3 months with suspected bacterial etiology instead receive a third-generation cephalosporin (e.g., ceftriaxone) or azithromycin. …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
Triage acute diarrhea (<14 days) by duration and severity: most is viral, self-limited, and needs only supportive care with hydration and no testing. Reserve stool testing (culture, Shiga toxin EIA, CDI two-step, GI multiplex PCR, O&P/antigens) for severe, bloody, febrile, immunocompromised, elderly, recent-antibiotic, or persistent (≥7 d) cases, and admit for sepsis, severe dehydration, AKI, or toxic appearance. Empiric antibiotics are not indicated for most acute watery diarrhea, and are not recommended even for bloody diarrhea in immunocompetent patients while awaiting stool results (IDSA strong, low); reserve empiric therapy for the specific indications: ill immunocompetent patients with fever documented in a medical setting, abdominal pain, and bloody diarrhea/bacillary dysentery presumptively due to Shigella; recent international travelers with temperature ≥38.5°C and/or signs of sepsis (weak, low); and immunocompromised patients with severe illness and bloody diarrhea (strong, low). When indicated, treat adults with a fluoroquinolone such as ciprofloxacin or with azithromycin, chosen by local susceptibility and travel history (strong, moderate); infants <3 months with suspected bacterial etiology instead receive a third-generation cephalosporin (e.g., ceftriaxone) or azithromycin. Avoid antibiotics in suspected STEC/EHEC (Shiga toxin 2-producing or O157; strong, moderate), and avoid loperamide/antimotility agents in EHEC, CDI, or any febrile/inflammatory (dysenteric) diarrhea.