What is the treatment for gastroenteritis?

From the Guidelines

Gastroenteritis treatment should focus on preventing dehydration and managing symptoms, with oral rehydration solutions and medications like loperamide and ondansetron used as needed, while avoiding antimotility agents in children and suspected cases of toxic megacolon or inflammatory diarrhea 1.

Treatment Approach

The primary goal of treating gastroenteritis is to prevent dehydration and manage symptoms. This can be achieved by:

• Drinking plenty of clear fluids like water, clear broths, or oral rehydration solutions such as Pedialyte, Gatorade (diluted for children), or homemade solutions (1 liter of water with 6 teaspoons of sugar and 1/2 teaspoon of salt) 1.
• Consuming at least 2-3 liters of fluid daily, taking small sips frequently rather than large amounts at once.
• Using over-the-counter medications like loperamide (Imodium) to reduce diarrhea in adults (2mg after each loose stool, maximum 8mg/day), but avoiding its use with high fever or bloody stools 1.
• Using ondansetron (Zofran) 4-8mg every 8 hours for vomiting, especially in children >4 years of age and adolescents with acute gastroenteritis associated with vomiting 1.

Important Considerations

• Avoid antimotility agents in children: Loperamide should not be given to children <18 years of age with acute diarrhea, as it can increase the risk of adverse events like ileus, abdominal distension, and lethargy 1.
• Avoid antimotility agents in suspected cases of toxic megacolon or inflammatory diarrhea: Loperamide should be avoided in suspected cases of toxic megacolon or inflammatory diarrhea, as it can worsen the condition 1.
• Monitor for severe dehydration and seek medical attention if necessary: Seek medical attention if experiencing severe dehydration signs, bloody stools, fever above 102°F (39°C), or symptoms lasting more than 3 days 1.

Additional Recommendations

• Follow the BRAT diet (bananas, rice, applesauce, toast) initially, then gradually reintroduce normal foods as symptoms improve.
• Rest is essential for recovery.
• Consider using azithromycin as first-line therapy for dysentery or acute watery diarrhea with greater than mild fever, due to its efficacy and safety profile 1.

From the Research

Treatment Options for Gastroenteritis

• Oral rehydration solutions, such as Pedialyte, Gatorade, and New Oral Rehydration Solution (N-ORS), can be effective in treating dehydration associated with mild viral gastroenteritis 2
• Modifications to the original oral rehydration salts formula, including low osmolarity, rice-based, glucose polymers, and the addition of probiotics, prebiotics, and/or zinc, may increase tolerability and shorten the duration of diarrhea 3

Management of Acute Gastroenteritis

• The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution 4
• Antiemetics can improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 4
• Patients at high risk due to extremes of age or immunosuppression may require specific therapy to ensure resolution of symptoms 5

Antibiotic Use in Acute Gastroenteritis

• Antibiotics should only be used in cases of acute gastroenteritis when empirically indicated, and modification of antibiotics should be made after confirming the pathogen 6
• The use of antibiotics in acute gastroenteritis should be guided by epidemiological factors, diagnostic tests, and indications for empirical antibiotics to decrease antibiotic misuse and prevent antibiotic resistance 6

Key Considerations

• Most cases of acute gastroenteritis require minimal medical intervention, but severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea 4, 5
• The diagnosis and management of acute gastroenteritis should be guided by recent guidelines from reputable organizations, such as the American College of Gastroenterology and the Infectious Diseases Society of America 5