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Infant On Azithromycin For Ear Infection. Noticed Blood And Mucus In Bowel Movement. What's Wrong?

Posted on Tue, 26 Feb 2013

Question: I have a 24 month old who was treated with azithromycin for ear infection 2 weeks ago. Prior to that she had taken two days of amoxicillin which didn't have effect so she was switched to zithromax. She finished the Zithromax on Friday and the following wednesday started to have soft but not loose bowel movements with a significant amount of mucus, sometimes with blood in the mucus. Since then she is having many (from 3-7) small soft bowel movements a day, some with mucus some without. She was able to make it to the potty most times before the onset of this, but I think she has increased urgency, as she doesn't make it anymore. It also appears that she is having some type of discomfort with the bowel moments as she cries or whines when they happen. She can't tell me if she has cramps or not. Her anal area isn't red so I assume its something inside that's hurting. She has had no fever. She eats and drinks like normal. Nothing else appears to be going on.

Answered by Dr. E Venkata Ramana (42 minutes later)

Hi,
Thank you for your query on Healthcare Magic,
As your child developed loose stools with blood in mucus, with urgency and discomfort before bowel movements it is looking like infective Gastroenteritis(Dysenery) due to a bacteria or a protozoal pathogen like entameba.
Another, but less possibility is antibiotic associated diarrhea as this episode started after the completion of antibiotic treatment with Zithromax.
Stool should be given for stool routine examination to look for any pus cells, ova and cyst and for stool for culture and sensitivity to look for the growth of any bacterial pathogen and its sensitivity to antibiotics.
Give sips of oral rehydrating solutions like Pedialyte(ORS) to prevent dehydration.
Probiotics like saccharomyces boulardi orally will help to normalise the gut flora in antibiotic associated and infective diarrheas.
So consult your Pediatrician for the assessment of your child, stool investigations and for specific treatment like emperical antibiotic and or antiprotozoal medication if required and and for probiotics.
Hope I have answered your query, if you have any clarification please let me know.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. E Venkata Ramana (2 hours later)

Thank you so much for your reply. We are submitting the stool samples to the lab today. Just mid morning today she has a low grade fever - 102. She is still eating and drinking and acting normal. We have an appointment in a week for her 2 year check up at the physicians office. I was hoping that the results would be back from the stool samples by then. Should I be worried about the fact she now has a fever? I have given tylenol this morning to see if it comes down.

Answered by Dr. E Venkata Ramana (9 hours later)

Hi,
Thank you for your query,
Fever is due to the infection which will be present during Gastroenteritis/Dysentery.
You can give Tylenol every 8th hourly depending on the presence of fever in prescribed dosage.
Maintain her hydration by giving oral rehydration fluids such as Pedialyte(ORS), coconut water and monitor her hydration status by her activity, skin turgor, tongue and oral cavity moisture, and her urine output.
Nothing to worry about the fever and it is because of gut infection.
But consult her Physician as early as possible(even if you don't get the results of stool samples) for clinical examination of the child and for empirical antibiotic treatment if required as she is having fever.
Hope I have answered your query, if you have any clarification please let me know.
Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar