Remember to check allergy status


Paediatric Treatment - Gastro-Intestinal Tract Infections

Clostridium difficile


Stop unnecessary antibiotics and/or PPIs and antiperistaltic agents1,2 B+
Mild cases (<4 episodes of diarrhoea per day) may respond without metronidazole. 70% respond to metronidazole in 5 days; 92% in 14 days3

If severe symptoms or signs (below) should treat with oral vancomycin, review progress closely and consider hospital referral.

Admit if severe: T >38.5; WCC >15, rising creatinine or signs/symptoms of severe colitis 1 C

Medicine Calendar

1st episode: metronidazole 1 A-

see BNFc

10-14 days

Severe/type 027/recurrent: oral vancomycin 1 A-

see BNFc

10-14 days then taper 1 C

Infectious diarrhoea


Antibiotic therapy not indicated unless systemically unwell. 2 C. If systemically unwell and Campylobacter spp suspected (e.g. undercooked meat and abdominal pain), consider clarithromycin for 5–7 days if treated early (within 3 days). 3 C
Refer previously healthy children with acute painful or bloody diarrhoea to exclude E. coli 0157 infection. 1 C

Medicine Calendar

If systematically unwell and Campylobacter spp suspected, consider clarithromycin if treated early (within 3 days).3 C

See BNFc

5–7 days



Treat all household contacts at the same time PLUS advise hygiene measures for 2 weeks (hand hygiene, pants at night, morning shower [include perianal area]) PLUS wash sleepwear, bed linen, dust, and vacuum on day one. 1 C
Child <6 mths add perianal wet wiping or washes 3 hourly during the day.

Medicine Calendar

All patients over 6 months:
mebendazole (off- label if <2yrs)

100mg 1 C

stat dose but repeat after 2 weeks if infestation persists

Child <6 mths mebendazole is unlicensed, use hygiene measures alone for 6 weeks1 C

Oral candidiasis

CKS- Oral Candida

Topical azoles are more effective than topical nystatin.

Oral candidiasis rare in immunocompetent adults; consider undiagnosed risk factors including HIV.

Fluconazole if extensive/severe candidiasis, or HIV or immunosuppression.

Medicine Calendar

miconazole oral gel 1,2,3,A-7

see BNFc

7 days or until 2 days after symptoms resolve 1A-

or nystatin suspension if miconazole not tolerated 1,2,4,5,7,A-

100,000 units QDS after meals

7 days or until 2 days after symptoms 7C

If extensive/severe candidiasis: fluconazole oral 4,5,6,7A-

see BNFc

7-14 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).