A 2 year old girl had blood in the stool

A close friend sent me this picture (no consent given by the owner as she is only 2 years old!):

A 2 year-old girl had blood in the stool for the past one day. She passed motion five times already. She had low grade fever of 37.8 degree Celsius. She was otherwise well, active and not in pain.

I told the father if she was less than one year old, I would definitely start antibiotic. This is because there is higher risk of severe disease in this group of small infants. As she is two years old and appeared well, I offered 2 choices:

• Wait and see -- as there is possibility of spontaneous resolution of symptoms
• Antibiotic therapy -- as this can kill the causative bacteria, reduce duration of illness and reduce transmission risks. The following article may be helpful:

"The antibiotics recommended by the WHO—ciprofloxacin, ceftriaxone and pivmecillinam—are effective in reducing the clinical and bacteriological signs and symptoms of dysentery and thus can be expected to decrease diarrhoea mortality attributable to dysentery." (Beatrix S Traa et al. Antibiotics for the treatment of dysentery in children. Int. J. Epidemiol. 39 (1) Pp. i70-i74)

The father preferred to wait and see. I agreed.
P/S I enjoy discussion with the care-takers regarding treatment to the baby. They understand the baby condition, agree on the treatment plan and thus unload their unnecessary anxiety.