Table 4.

World Health Organization (WHO) Diarrhea Management Guidelines for Children ≤5 Years^a

Dehydration Management (Without Severe Acute Malnutrition)	WHO-indicated Treatment
Severe (Plan C-Facility)	Start IV fluid immediately (preferably ringers Lactate Solution [100 ml/kg]) Reassess every 15–30 mins Give ORS (5 ml/kg/hr) as soon as the child can drink Re-classify dehydration after 6 h in infant & 3 h in child and continue with A, B, C plan	<12 m age—30 ml/kgb in one hour followed by 70 ml/kg over 5 h 12 m to 5 y age—30 ml/kgb in 30 min followed by 70 ml/kg over 2.5 h
Some (Plan B-Facility)	Give recommended ORS in clinic over 4 h	Agec	<4 m	4–<12 m	12–<2 y	2 y– ≤ 5 y
	Re-classify dehydration after 4 h and continue with A, B, C plan	Weight	<6 kg	6–<10 kg	10–<12 kg	12–19 kg
			200–400 ml	400–700 ml	700–900 ml	900–1400 ml
None (Plan A-Home)	Increase food and fluid intake to prevent dehydration
Dehydration Management (With Severe Acute Malnutrition & No Shock)	WHO-indicated Treatment
Severe (Plan C-Facility)	Give ReSoMald (or half-strength standard low ORS with added potassium & glucose) 5 ml/kg every 30 min for the first 2 h 5–10 ml/kg per h for the next 4–10 for the next hours on alternate hours with F75
Some (Plan B-Facility)	Same as above
None (Plan A-Home)	Not applicable (because child admitted)
Zinc	WHO-indicated Treatment
All children	Zinc supplementation for 10–14 d ≤6 m 10 mg per day >6 m 20 mg per day
Antibiotics	WHO-indicated Treatment
Dysentery	Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity Azithromycin (10 mg/kg) given once daily for 4 d OR based on local sensitivity IV/IM ceftriaxone at 50–80 mg/kg per day for 3 d (if child is severely ill or as second line treatment)
Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)	Erythromycin (12 mg/kg) four times a day for 3 d Ciprofloxacin 10–20 mg/kg twice per day for 5 d Cotrimoxazole 4 mg/kg trimethoprim & 20 mg/kg sulfamethoxazole twice a day

Abbreviation: F75, full formula name; IM, intramuscular; IV, intravenous; ORS, oral rehydration solution; ReSoMal, rehydration solution for malnutrition; WHO, World Health Organization.

^aWorld Health Organization. Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. Geneva, Switzerland. WHO 2013; World Health Organization. Chart Booklet: Integrated Management of Childhood Illness. Geneva, Switzerland. WHO 2014; World Health Organization. The WHO Essential Medicines List Antibiotic Book: improving antibiotic AWaReness. Geneva, Switzerland. WHO 2021.

^bRepeat if the radial pulse is still very weak or not detectable.

^cUse the child's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child's weight (in kg) by 75.

^dIf rehydration still required at 10 h, give starter F-75 instead of ReSoMal, at the same times.