From the Guidelines
The management of viral gastroenteritis should primarily focus on supportive care, preventing dehydration, and using oral rehydration therapy as the cornerstone of treatment, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal of treatment is to prevent dehydration and reduce the risk of complications. Oral rehydration therapy can be achieved with solutions like Pedialyte or homemade mixtures, with adults consuming 2-3 liters daily and children needing 1 ml/kg of fluid per hour.
- Key points to consider in the management of viral gastroenteritis include:
- Starting with small sips every 5-10 minutes if vomiting is present
- Gradually progressing the diet from clear liquids to the BRAT diet (bananas, rice, applesauce, toast) and then to a normal diet as tolerated
- Avoiding anti-diarrheal medications like loperamide in children and those with bloody diarrhea or high fever
- Using antiemetics such as ondansetron to control vomiting
- Seeking medical attention for severe dehydration, persistent symptoms, blood in stool, or high fever
- Prevention measures are also crucial, including hand hygiene with soap and water, proper food preparation and storage, and avoidance of high-risk foods and unsafe water, as highlighted in the guidelines 1.
- It is essential to note that most cases of viral gastroenteritis are self-resolving, and laboratory investigation is generally not warranted, unless there are epidemiologic or clinical features that justify the expense and complexity of laboratory testing 1.
From the Research
Management of Viral Gastroenteritis
The management of viral gastroenteritis typically involves supportive care, with a focus on preventing dehydration and managing symptoms.
- Oral rehydration therapy is a key component of management, with solutions such as Pedialyte, Gatorade, and New Oral Rehydration Solution (N-ORS) being effective in correcting dehydration and improving bowel symptoms 2.
- In children, oral rehydration therapy is as effective as intravenous fluid therapy for rehydration in cases of mild-to-moderate dehydration 3, 4.
- Measurements of serum electrolytes, creatinine, and glucose are usually not necessary, unless the child has severe dehydration and requires hospitalization and intravenous therapy 3.
- The use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for intravenous therapy and hospitalization 3, 5.
- In cases of refractory vomiting, intravenous ondansetron or dexamethasone may be used in addition to intravenous fluid therapy to improve oral fluid tolerance and reduce hospital admission rates 5.
Prevention and Education
- Physicians should educate caregivers on proper personal hygiene and handwashing to prevent fecal-to-oral transmission of the pathogen 3.
- The importance of rotavirus vaccine in preventing rotavirus gastroenteritis should also be emphasized 3.
- Several norovirus vaccines are currently undergoing clinical trials, with promising results, and may further reduce the incidence of viral gastroenteritis in the future 3.
Treatment Approaches
- The American College of Gastroenterology and the Infectious Diseases Society of America have published guidelines for the diagnosis and management of acute gastroenteritis, which provide a best-evidence approach to treatment 6.
- Treatment approaches may vary depending on the severity of symptoms, age, and immunosuppression status of the patient 6.
- Supportive care, including oral rehydration therapy and management of symptoms, is often sufficient for patients with mild cases of viral gastroenteritis 2, 3, 4, 6.