Antibiotics for Clinical Dysentery in the Pediatric Emergency Department - Are We Overtreating?

Background: Clinical dysentery (CD) causes thousands of deaths annually world-wide. However, current recommendations reserve antibiotics for those either clinically sick or with highly suspected cases of shigellosis. Children diagnosed with clinical dysentery in the pediatric emergency department (PED) are regarded more cautiously. This study explores the use of antibiotics in children diagnosed with clinical dysentery in the PED. Methods: A retrospective case study of children with clinical dysentery at a single PED during the years 2015-2018. Demographics as well as clinical findings were compared to culture results and antibiotic treatment. Results: 281 children were diagnosed with CD during the study period. 234 (83%) were treated with antibiotics. However, cultures were positive in only 162 (58%) cases. Only 32% were shigella spp. Younger age, fever and leukocytosis were related to antibiotic treatment. Conclusion: The diagnosis of CD is misgiven commonly in the PED leading to wide spread use of antibiotics when not indicated. This may impact antibiotic resistance patterns seen. Further studies and interventions are necessary to create clear guidelines also in the PED setting.