What are the treatment instructions for viral gastroenteritis with diarrhea?

From the Guidelines

Treatment for viral gastroenteritis with diarrhea should focus on preventing dehydration through fluid replacement and symptom management, with adults consuming at least 2-3 liters of fluid daily and children needing smaller, more frequent amounts, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The primary goal is to prevent dehydration, and this can be achieved by drinking plenty of clear fluids like water, clear broths, or oral rehydration solutions such as Pedialyte, Gatorade, or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of water). Some key points to consider in the management of viral gastroenteritis with diarrhea include:

• Gradually reintroducing bland, easy-to-digest foods like bananas, rice, applesauce, toast (BRAT diet), crackers, and boiled potatoes once vomiting subsides
• Considering the use of over-the-counter medications such as loperamide (Imodium) to help reduce diarrhea in adults, but avoiding its use in children and cases with high fever or bloody stools, as advised by the guidelines 1
• Using antiemetic agents like ondansetron to facilitate oral rehydration in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting, as supported by the evidence 1
• Avoiding the use of antimotility agents in patients with suspected or proven cases of toxic megacolon, inflammatory diarrhea, or diarrhea with fever, due to the potential risk of complications 1
• Advising patients about medications that may increase the risk of complications from diarrhea, particularly antidiarrheal and antimicrobial agents, and avoiding their use when possible 1
• Seeking medical attention if symptoms include severe dehydration, bloody stools, high fever above 102°F (39°C), or if symptoms persist beyond 3 days.

From the FDA Drug Label

Dehydration Fluid and electrolyte depletion often occur in patients who have diarrhea In such cases, administration of appropriate fluid and electrolytes is very important. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).

The treatment instructions for viral gastroenteritis with diarrhea include:

• Administration of appropriate fluid and electrolytes to prevent dehydration
• Symptomatic treatment with loperamide hydrochloride
• Determining the underlying etiology and providing specific treatment when appropriate 2 Key points:
• Loperamide hydrochloride does not replace the need for fluid and electrolyte therapy
• Treatment with loperamide hydrochloride is only symptomatic
• Patients should be monitored for signs of abdominal distention, constipation, or ileus, and the medication should be discontinued promptly if these occur 2

From the Research

Treatment Instructions for Viral Gastroenteritis with Diarrhea

• The primary treatment for viral gastroenteritis with diarrhea is oral rehydration therapy, which can be as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 3, 4.
• Oral rehydration solutions, such as Pedialyte or Gatorade, can be used to correct dehydration and improve bowel symptoms 5.
• A yogurt/rice diet can be allowed ad libitum in addition to oral rehydration therapy 5.
• Measurements of serum electrolytes, creatinine, and glucose are usually not necessary and should only be considered in a subset of patients with severe dehydration who require hospitalization and IV therapy 6.
• Judicious use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization 6, 3.
• Hospitalization and intravenous fluids are recommended for patients who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration 3.

Prevention of Viral Gastroenteritis

• Handwashing, breastfeeding, and rotavirus vaccination can reduce the incidence of acute gastroenteritis in young children 6, 3.
• Proper personal hygiene and handwashing can prevent fecal to oral transmission of the pathogen 6.
• Several norovirus vaccines are currently undergoing clinical trials with promising results, which may further reduce the incidence of viral gastroenteritis 6.

Management of Dehydration

• The four-item Clinical Dehydration Scale can be used to determine the severity of dehydration based on physical examination findings 3.
• Oral rehydration therapy is recommended for mild to moderate dehydration, while intravenous fluids are recommended for severe dehydration 3, 4.
• Low osmolarity oral rehydration solutions, rice-based solutions, and solutions with glucose polymers as an alternative to glucose may be more effective and better tolerated than traditional oral rehydration solutions 7.