What antimicrobials can be used with ORS in the clinical management of diarrhoea?
Antimicrobials should not be used routinely. This is because it is not possible to distinguish clinically episodes that might respond, such as diarrhoea caused by enterotoxigenic E. coli, from those caused by agents unresponsive to antimicrobials, such as rotavirus or cryptosporidium. Moreover, even for potentially responsive infections, selecting an effective antimicrobial requires knowledge of the likely sensitivity of the causative agent, information that is usually unavailable. In addition, use of antimicrobials adds to the cost of treatment, risks adverse reactions and enhances the development of resistant bacteria. Antimicrobials are reliably helpful only for children with bloody diarrhoea (probable shigellosis), suspected cholera, and serious non-intestinal infections such as pneumonia. Anti-protozoal drugs are rarely indicated.
