What is the management and treatment of gastroenteritis?

From the Guidelines

Gastroenteritis is inflammation of the stomach and intestines, and its management primarily focuses on preventing dehydration through oral rehydration therapy.

Management and Treatment

The goal of treatment is to prevent dehydration, reduce symptom duration, and prevent complications.

• For mild to moderate dehydration, oral rehydration solutions like Pedialyte or homemade solutions (1 liter of water with 6 teaspoons of sugar and 1/2 teaspoon of salt) should be consumed frequently in small amounts 1.
• Adults should drink 2-3 liters daily, while children need 1 ml of fluid per gram of stool output.
• In severe cases, intravenous fluids may be necessary 1.
• Diet should consist of easily digestible foods like bananas, rice, applesauce, and toast (BRAT diet), gradually returning to normal eating as symptoms improve.
• Medications are generally not required, but in specific cases, antiemetics like ondansetron (4-8 mg every 8 hours for adults) can help with severe vomiting 1.
• Antibiotics are only indicated for certain bacterial causes like Shigella (ciprofloxacin 500 mg twice daily for 3-5 days) or for immunocompromised patients 1.
• Azithromycin should be considered the first-line agent in cases of dysentery 1.
• Probiotics such as Lactobacillus or Saccharomyces boulardii may help reduce symptom duration.
• Most importantly, practice good hygiene by washing hands thoroughly with soap and water, especially after using the bathroom and before handling food, to prevent spreading the infection to others. Gastroenteritis is typically self-limiting, with symptoms resolving within 2-5 days as the body clears the infection naturally.

Key Considerations

• Replacement of water, electrolytes, and nutrients lost during diarrhea is essential in the management of diarrhea 1.
• Low-osmolarity ORS can be given to all age groups, with any cause of diarrhea 1.
• Antibiotics have been demonstrated to reduce symptom duration in TD from an average of 50-93 to 16–30 hours 1.
• FQs retain efficacy in much of the developing world with the previous caveats regarding resistance in Campylobacter spp. and now other enteric pathogens 1.
• Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to FQs in non-invasive TD caused by diarrheagenic E. coli 1.

Recommendations

• Reduced ORS is recommended as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
• Isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered when there is severe dehydration, shock, or altered mental status and failure of ORS therapy 1.
• Once the patient is rehydrated, maintenance fluids should be administered 1.
• Replace ongoing losses in stools from infants, children, and adults with ORS, until diarrhea and vomiting are resolved 1.

From the Research

Definition of Gastroenteritis

• Gastroenteritis is inflammation of the stomach and intestines 2
• It can be caused by viruses, bacteria, or parasites, with viruses being the most common cause 2

Management and Treatment of Gastroenteritis

• The management of gastroenteritis depends on the severity of the symptoms 2
• Patients with mild or moderate symptoms can be treated with oral hydration, while those with more severe illness may require nasogastric or intravenous hydration 2
• Antiemetic, antimotility, and/or antisecretory drugs can be used for symptom control 2
• Antimicrobial therapy is indicated for certain infections, such as C. difficile, travel-related diarrhea, and parasitic infections 2

Treatment of Nausea and Vomiting in Gastroenteritis

• Ondansetron has been shown to be effective in treating nausea and vomiting in patients with acute gastroenteritis 3, 4
• Metoclopramide can also be used, but it may have more side effects, such as weakness and akathisia 3, 5
• Domperidone has also been studied as a treatment option, but its efficacy is not as well established as ondansetron 4

Diagnostic Approach

• The diagnostic approach to gastroenteritis varies with symptom severity 2
• Microbial studies are not needed for patients with mild symptoms that resolve within a week, but longer-lasting or more severe symptoms may require microbial studies 2
• Recent antibiotic exposure should prompt testing for C. difficile 2