From the Guidelines
The first-line treatment for gastroenteritis is oral rehydration therapy (ORT) to replace lost fluids and electrolytes, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
Key Components of Oral Rehydration Therapy
- Patients should consume oral rehydration solutions like Pedialyte, or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of clean water) 1.
- Adults should drink 2-3 liters per day in small, frequent sips, while children's intake should be based on weight (50-100 mL/kg over 4 hours for mild to moderate dehydration) 1.
- Clear broths, diluted fruit juices, and water are also beneficial.
- Rest is important, and a gradual return to a normal diet is recommended, starting with bland, easy-to-digest foods like bananas, rice, applesauce, and toast (BRAT diet).
Medications and Additional Considerations
- Medications like loperamide (Imodium) can help control diarrhea in adults but should be avoided in children and cases with bloody diarrhea or high fever 1.
- Antibiotics are generally not recommended unless bacterial infection is confirmed 1.
- Antimotility drugs, such as loperamide, should not be given to children <18 years of age with acute diarrhea 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.
Importance of Oral Rehydration Therapy
Oral rehydration therapy is essential in preventing dehydration, which is the main complication of gastroenteritis 1. It works by replacing essential fluids and electrolytes lost through vomiting and diarrhea.
Summary of Recommendations
- Oral rehydration therapy is the first-line treatment for gastroenteritis.
- Medications like loperamide can help control diarrhea in adults, but should be avoided in children and cases with bloody diarrhea or high fever.
- Antibiotics are generally not recommended unless bacterial infection is confirmed.
- A gradual return to a normal diet is recommended, starting with bland, easy-to-digest foods.
From the Research
First-Line Treatment for Gastroenteritis
The first-line treatment for gastroenteritis typically involves oral rehydration therapy (ORT) to prevent dehydration, which is a serious complication of gastroenteritis 2, 3, 4.
- Oral rehydration solutions (ORS) are effective and inexpensive, and their use has revolutionized the management of acute gastroenteritis in children and adults 3.
- The World Health Organization recommends the use of low-osmolarity ORS solutions, which have been shown to be effective in preventing dehydration and reducing the need for intravenous therapy 2, 3.
- In cases where vomiting is a significant symptom, anti-emetic medications such as ondansetron may be used to facilitate ORT and reduce the need for intravenous hydration and hospitalization 5, 4, 6.
Use of Anti-Emetic Medications
Anti-emetic medications, particularly ondansetron, have been shown to be effective in reducing vomiting episodes in children with acute gastroenteritis 5, 4, 6.
- Ondansetron has been found to be superior to other anti-emetic medications in the treatment of gastroenteritis-related vomiting 5.
- The use of ondansetron has been associated with lower hospital admission rates and reduced need for intravenous rehydration 4, 6.
- However, the use of anti-emetic medications should be judicious and based on individual patient needs, as they may have potential adverse effects 5, 4.
Comparison of Oral and Intravenous Rehydration
Oral rehydration therapy has been compared to intravenous rehydration therapy in several studies, with findings suggesting that ORT is a safe and effective first-line treatment for gastroenteritis 2, 4.