From the Guidelines
To treat gastroenteritis, focus first on preventing dehydration by drinking plenty of clear fluids like water, diluted fruit juices, or oral rehydration solutions such as Pedialyte, Gatorade, or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of water) 1. The goal is to prevent dehydration and manage symptoms.
Key Considerations
- Start with small sips every 5-10 minutes if vomiting is present.
- Gradually reintroduce bland foods like bananas, rice, applesauce, toast (BRAT diet), plain crackers, and boiled potatoes once you can tolerate liquids.
- For symptom relief, over-the-counter medications like loperamide (Imodium) can help control diarrhea in adults, but should be avoided in children or if there's blood in stool or fever, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
- Antinausea and antiemetic agents, such as ondansetron, may be given to facilitate tolerance of oral rehydration in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting 1.
- Bismuth subsalicylate (Pepto-Bismol) may help with both diarrhea and nausea, although it is only mildly effective 1.
- Acetaminophen can reduce fever and discomfort.
When to Seek Medical Attention
- Severe dehydration (extreme thirst, dry mouth, little/no urination, severe weakness)
- Bloody diarrhea
- Persistent vomiting
- High fever above 102°F (39°C)
- Symptoms lasting more than 3 days These may indicate a more serious condition requiring medical intervention.
Important Notes
- Most cases of gastroenteritis resolve within 1-3 days without antibiotics, as it is typically viral 1.
- Patients should be advised about medications with the potential to increase the risk of complications from diarrhea, particularly antidiarrheal and antimicrobial agents 1.
From the FDA Drug Label
Dehydration Fluid and electrolyte depletion often occur in patients who have diarrhea In such cases, administration of appropriate fluid and electrolytes is very important. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).
Treatment for gastroenteritis involves:
- Administration of appropriate fluid and electrolytes to prevent dehydration
- Symptomatic treatment with loperamide hydrochloride, if necessary
- Specific treatment for the underlying cause of gastroenteritis, when determined 2
From the Research
Treatment Options for Gastroenteritis
- Oral rehydration therapy is the mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis 3
- The World Health Organization recommends a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis 4
- Modifications to the original oral rehydration salts formula have been proposed, including low osmolarity, rice-based, glucose polymers, and the addition of probiotics, prebiotics, and/or zinc 4
Management of Gastroenteritis in Children
- A child with minimal or no dehydration should be encouraged to continue their usual diet plus drink adequate fluids 5
- Oral rehydration therapy with a rehydration solution can be used to treat diarrhea in children with mild to moderate dehydration 5
- Ondansetron can decrease vomiting or help avoid the need for intravenous fluid, but it increases episodes of diarrhea 5
- Probiotics can be used to shorten the course of diarrhea 5
Role of Antiemetics and Oral Rehydration Solutions
- Antiemetics, such as ondansetron, can improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 3, 6
- Oral rehydration solutions, such as Pedialyte and Gatorade, can be effective in correcting dehydration and improving bowel symptoms 7
- The addition of ondansetron to an oral rehydration protocol can reduce rates of intravenous fluid administration and admissions in children with gastroenteritis 6