Recommendations for the diagnosis and management of pediatric acute gastroenteritis in Israel

BACKGROUND: Nearly all children will experience at least one episode of acute gastroenteritis (AGE) by the age of three years. Acute gastroenteritis is a common cause of admissions to the pediatric wards in Israel, but usually the disease is mild. AIM: This paper aims to present guidelines for diagnosis and management of pediatric AGE in Israel, based on the recently published European recommendations after adjustment to the Israeli setup. METHODS: The recommendations arising from the systematic review of the literature were graded by level of evidence. The guidelines were endorsed by the Israeli associations of Pediatric Gastroenterology, Pediatric Infectious Diseases and Pediatrics. RESULTS: The clinical signs with the predictive value for dehydration are weight loss, prolonged capillary refill, poor turgor, reduced urinary output and abnormal respiration. Routine stool or blood cultures are not recommended. Reduced or low osmolarity oral rehydration solutions (ORS) are the first line therapy for rehydration. Full diet, including lactose, should be resumed following the four hours required for rehydration. In most cases no medications are required for this self-limited disease but certain types of probiotics may shorten the diarrheal episode and reduce its severity. Antimicrobial therapy is not recommended in most cases but should be considered in shigellosis, during the first three days of campylobacter infectious and in other selected cases. Vaccination against rotavirus is recommended as per the recent European, American and Israeli guidelines. CONCLUSION: Implementation of the scientific evidence in clinical practice, may improve the standard of care of pediatric AGE in Israel.