What is the treatment for Norovirus (Norwalk virus) infection?

From the Guidelines

Norovirus treatment focuses on managing symptoms and preventing dehydration, as there is no specific antiviral medication for this illness. The most recent and highest quality study, 1, published in 2017, emphasizes the importance of proper hydration and supportive care in managing norovirus infections. Rest and drink plenty of fluids like water, sports drinks, or oral rehydration solutions such as Pedialyte to replace lost electrolytes. Adults can take over-the-counter medications like loperamide (Imodium) for diarrhea and acetaminophen (Tylenol) for fever and body aches, following package dosing instructions. Avoid anti-diarrheal medications for children without medical advice. Most people recover within 1-3 days with proper hydration.

Key Considerations

• Seek medical attention if you experience severe dehydration symptoms (extreme thirst, dizziness, minimal urination), persistent vomiting preventing fluid intake, bloody diarrhea, or if symptoms last longer than three days.
• Norovirus is highly contagious, so wash hands thoroughly with soap and water, disinfect contaminated surfaces with bleach-based cleaners, and avoid preparing food for others while sick and for at least 48 hours after symptoms resolve to prevent spreading the infection.

Prevention Strategies

• Proper hand hygiene is crucial in preventing norovirus infection, with thorough handwashing with running water and plain or antiseptic soap being the most effective method 1.
• Avoid bare-hand contact with ready-to-eat foods and ensure proper cleaning and sanitizing of equipment and surfaces 1.
• Exclude ill staff and individuals from certain positions, such as food handlers, until 48-72 hours after symptom resolution, and isolate ill residents, patients, and passengers in closed or institutional settings until 24-48 hours after symptom resolution 1.

From the Research

Treatment Options

• There are no well-designed clinical trials to support specific treatments for norovirus infection 2
• Several treatment strategies have been suggested in case reports, including:
  • Nitazoxanide
  • Ribavirin
  • Enterally administered immunoglobulin
  • Favipiravir (although not tested on humans) 3
• Antiviral therapy may be effective in immunocompromised patients, but further research is needed to develop an effective antiviral therapy 4

Management Strategies

• Early identification of norovirus infection and prompt initiation of supportive therapy are required to reduce morbidity and mortality 5
• Measures to prevent outbreaks and reduce the risk of norovirus infection include:
  • Timely diagnosis
  • Implementation of infection control interventions to limit virus transmission 5
  • Good hand hygiene
  • Adherence to infection control procedures
  • Limiting contamination of food, water, and the wider environment 2, 6

Supportive Care

• Supportive care is essential for managing norovirus infection, particularly in immunocompromised patients who may require prolonged hospitalization and intensive supportive care 4
• Supportive care may include:
  • Fluid replacement
  • Electrolyte management
  • Nutrition support
  • Symptomatic treatment of nausea, vomiting, and diarrhea 3, 4