Complex issues of prescribing empirical antibacterial therapy for acute intestinal infections in children

Objective: to analyze the clinical and anamnestic features of the course of acute intestinal infections depending on the etiology, to identify the features of the course of viral acute intestinal infections that served as a reason for prescribing empirical antibacterial therapy in children under 5 years old upon admission to the hospital.
Materials and methods. The retrospective case-control study included 66 case histories of children with acute intestinal infections aged from 1 month to 4 years inclusive, hospitalized in 2023—2024 at Pediatric City Clinical Hospital No. 9 named after G.N. Speransky, Moscow. Etiological decoding of acute intestinal infections was carried out using PCR testing of feces samples, bacteriological testing of feces. 
Results. In children under 5 years old, viral intestinal infections predominated, with norovirus identified in 52% of cases (95% CI: 37—67%). In bacterial intestinal infections in children, complaints of diarrhea with blood and mucus, fever up to febrile values, abdominal pain were more common. The presence of vomiting lasting more than three days before admission and upon admission to the hospital were more common in acute intestinal infections of viral etiology. Antibacterial therapy was carried out in all children with bacterial acute intestinal infections, and in 57% (95% CI: 41—70%) cases of viral acute intestinal infections. Antibacterial therapy among patients with viral acute intestinal infections was significantly more often received by children with fever, other clinical and anamnestic differences could not be identified. 
Conclusion. The combined assessment of both clinical and anamnestic data in acute intestinal infections can serve as a basis for creating an algorithm for rapid clinical assessment of indications for empirical antibacterial therapy.

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