What is the treatment for gastroenteritis?

From the Guidelines

The primary treatment for gastroenteritis is focused on preventing dehydration through fluid replacement, with oral rehydration solutions being the first line of therapy, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal is to replace lost fluids, electrolytes, and nutrients.

• Oral rehydration solutions like Pedialyte or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of clean water) should be consumed in small, frequent amounts.
• Adults should aim for 2-3 liters daily, while children need 1 ml of fluid per gram of diarrheal stool. For symptom relief,
• over-the-counter medications like loperamide (Imodium) can help with diarrhea in adults, but should be avoided in children and cases with bloody diarrhea or high fever, as stated in the guidelines 1.
• Antinausea and antiemetic agents, such as ondansetron, may be given to facilitate tolerance of oral rehydration in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting 1. It is essential to follow the BRAT diet (bananas, rice, applesauce, toast) initially, then gradually return to normal eating. Antibiotics are rarely needed unless bacterial infection is confirmed, and their use should be guided by the severity of illness and regional patterns of antimicrobial resistance, with azithromycin being recommended as the first-line agent in cases of dysentery or acute watery diarrhea with greater than mild fever 1. Rest is essential, and most cases resolve within 1-3 days. Seek medical attention if symptoms persist beyond 3 days, if there's severe dehydration, bloody stools, or high fever, as these may indicate a more serious condition requiring additional treatment.

From the Research

Treatment for Gastroenteritis

The treatment for gastroenteritis primarily focuses on preventing and managing dehydration, as well as alleviating symptoms. Key aspects of treatment include:

• Provision of adequate fluids to prevent and treat dehydration 2
• Use of oral rehydration solutions or intravenous rehydration in severe cases 2, 3
• Administration of antiemetics, such as ondansetron, to decrease vomiting and improve oral intake 3
• Avoidance of routine use of antiemetics in young children, unless necessary 3
• Consideration of antibiotic use in specific cases, such as bacterial infections, and adherence to guidelines to prevent antibiotic misuse and resistance 4

Management Approaches

Different management approaches are recommended based on the severity of dehydration and the patient's overall condition:

• Oral rehydration therapy for mild to moderate dehydration 3
• Intravenous rehydration for severe dehydration or when oral rehydration is not possible 3
• Use of lactose-free feeds and enteral rehydration solutions in certain cases 2
• Consideration of rotavirus vaccines for prevention of gastroenteritis in children 2

Supportive Care

Supportive care is crucial in managing gastroenteritis, including:

• Preventing dehydration or providing appropriate rehydration 5
• Managing symptoms such as nausea, vomiting, and abdominal pain
• Providing public health education and implementing contact precautions to decrease the prevalence of infectious agents like Clostridium difficile 5