The Aetiology of Acute Gastroenteritis in Children in Malta and the Role of Empirical Antibiotics in this Condition

Abstract

Background: Rotavirus is the leading cause of gastroenteritis in Europe.  No specific clinical feature differentiates bacterial from viral gastroenteritis.  Acute gastroenteritis self-resolves without antibiotics in the majority of healthy children regardless of the aetiology.  Empirical antibiotics should only be prescribed for specific indications, as stated in the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) / European Society for Pediatrics Infectious Diseases (ESPID) Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe.  This audit aimed to assess the prevalence of the different pathogens causing acute gastroenteritis in children in Malta and to establish whether empirical antibiotics are being prescribed according to the aforementioned guidelines. 

Method: All children admitted to Mater Dei Hospital between 1^st September 2019 and 29^th February 2020 with acute gastroenteritis were included.  The data was collected retrospectively from iSOFT Clinical Manager and medical records. The results were compared to the aforementioned guidelines. 

 Results: Rotavirus was the most commonly identified pathogen accounting for 37.9% of all cases.  Non-typhoid Salmonella was the commonest bacterial cause.  Empirical antibiotics were prescribed in 20.3% of all cases but were indicated in 8.4%.   Empirical antibiotics were only indicated in 37.9% of the patients who received them.  The commonest indicator was severe toxaemia.

 Conclusion: Rotavirus is the leading cause of acute gastroenteritis in children in Malta.  The majority of patients (79.7%) were not prescribed empirical antibiotics in accordance with the guidelines. However, only 37.9% of the prescribed empirical antibiotics were indicated, hence their use could still be reduced further.