From the Guidelines
The primary treatment for gastroenteritis is oral rehydration with solutions like Pedialyte, aiming to prevent dehydration and replace lost electrolytes, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1, 2. The goal is to consume these solutions in small, frequent sips, with adults aiming for 2-3 liters daily and children needing 1 ml of fluid per kilogram of body weight per hour.
- For mild to moderate dehydration, oral rehydration solutions (ORS) are the first-line therapy, with reduced ORS recommended for infants, children, and adults 2.
- If vomiting is severe, anti-emetics like ondansetron may be given to facilitate tolerance of oral rehydration, especially in children over 4 years and adolescents 3.
- For diarrhea, loperamide may provide relief in immunocompetent adults with acute watery diarrhea but should be avoided in children under 18, and in cases of suspected or proven toxic megacolon, inflammatory diarrhea, or diarrhea with fever 1. Key considerations include:
- Rest is essential for recovery.
- Most cases resolve within 1-3 days without antibiotics, as gastroenteritis is typically viral.
- Seek medical attention if symptoms persist beyond 3 days, or if there's severe dehydration, bloody stools, or high fever. It's crucial to note that while certain medications can help manage symptoms, the cornerstone of treatment remains fluid replacement and monitoring for signs of severe dehydration or other complications that may require medical intervention 2.
From the Research
Treatment Overview
The treatment for gastroenteritis primarily focuses on rehydration and management of symptoms. According to 4, the mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution.
Oral Rehydration Solutions
- Oral rehydration solutions (ORS) are a crucial component in the management of acute gastroenteritis, as they help prevent and treat dehydration 5.
- The World Health Organization recommended a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis 6.
- Modifications to the original ORS formula have been proposed to increase tolerability and shorten the duration of diarrhea, including low osmolarity, rice-based, glucose polymers, and the addition of probiotics, prebiotics, and/or zinc 6.
Management of Dehydration
- For patients with severe dehydration and hypoglycemia, intravenous fluids may be necessary 4.
- Antiemetics can be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 4.
- A study comparing Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS) found that all three solutions were effective in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 7.