From the Guidelines
Gastroenteritis treatment should primarily focus on preventing dehydration through fluid replacement, and the use of antimotility agents like loperamide may be considered in adults, but not in children under 18 years of age, as stated in the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal of treatment is to prevent dehydration and manage symptoms while the infection runs its course.
- Key considerations for treatment include:
- Fluid replacement: drinking plenty of clear fluids like water, clear broths, or oral rehydration solutions such as Pedialyte, to prevent dehydration.
- Symptom management: using over-the-counter medications like loperamide (Imodium) to reduce diarrhea, but only in adults and with caution, as it may increase the risk of complications in certain cases 1.
- Dietary changes: following a bland diet with foods like bananas, rice, applesauce, toast, and crackers, while avoiding dairy, fatty, spicy, or sugary foods until recovery.
- It is essential to seek medical attention if symptoms persist or worsen, such as severe dehydration, bloody diarrhea, or high fever, as these may indicate a bacterial infection requiring prescription antibiotics 1.
- The use of antibiotics, such as azithromycin, may be considered in cases of severe travelers' diarrhea or dysentery, but the decision to treat should be based on the severity of illness and the effects it will have on the patient's activities and plans 1.
From the Research
Gastroenteritis Treatment Overview
- Gastroenteritis treatment primarily focuses on rehydration and managing symptoms, as most cases are self-limiting and require minimal medical intervention 2.
- The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis is oral rehydration solution, which can be supplemented with antiemetics to improve tolerance and reduce the need for intravenous fluids and hospitalization 2.
Oral Rehydration Solutions
- Studies have compared the efficacy of different oral rehydration solutions, including Pedialyte, Gatorade, and new oral rehydration solutions (N-ORS), finding that they are similarly effective in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 3.
- In children with mild gastroenteritis and minimal dehydration, dilute apple juice and preferred fluids have been shown to be non-inferior to electrolyte maintenance solution, with fewer treatment failures and less need for intravenous rehydration 4.
Antibiotic Use
- Antibiotics are not recommended for the treatment of acute gastroenteritis in most cases, as they do not reduce symptom duration or improve outcomes, and may contribute to antibiotic resistance 5.
- Guidelines for antibiotic use in acute gastroenteritis emphasize the importance of epidemiological factors, diagnostic testing, and targeted therapy to minimize misuse and prevent resistance 5.
Advances in Oral Rehydration Therapy
- Modifications to the original oral rehydration salts formulation have been proposed to improve tolerability, reduce symptom duration, and enhance parental quality of life, including low osmolarity, rice-based, and glucose polymer-based solutions, as well as the addition of probiotics, prebiotics, and zinc 6.
- These changes aim to address the limitations of the original formulation, which does not reduce stool volume or frequency, and may not be widely accepted due to its taste and effectiveness 6.