What is the first-line treatment for gastroenteritis?

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 1. Patients should consume oral rehydration solutions like Pedialyte, or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of clean water) in small, frequent sips. Some key points to consider in the treatment of gastroenteritis include:

• Adults should aim for 2-3 liters per day, while children's intake should be based on weight (50-100 mL/kg over 4 hours for mild dehydration) 1.
• Clear broths, diluted juices, and water can supplement these solutions.
• Patients should follow the BRAT diet (bananas, rice, applesauce, toast) or other bland, easy-to-digest foods once vomiting subsides.
• Anti-diarrheal medications like loperamide (Imodium) can be used by adults but should be avoided in children and cases with bloody diarrhea or high fever 1.
• Rehydration is crucial because gastroenteritis causes fluid loss through vomiting and diarrhea, which can lead to dangerous dehydration.
• Most cases resolve within 3-5 days with proper fluid replacement, though patients should seek medical attention if symptoms persist beyond 5 days, if there's blood in stool, high fever, severe abdominal pain, or signs of severe dehydration. In cases of severe dehydration, intravenous rehydration may be necessary, and patients should be monitored closely for signs of complications 1. It's also important to note that antimotility and antisecretory agents can be used to shorten the duration of diarrhea in adults, and antiemetic agents can be used to facilitate oral rehydration in people with significant vomiting 1. However, these medications should be used with caution and under the guidance of a healthcare professional.

From the Research

First-Line Treatment for Gastroenteritis

The first-line treatment for gastroenteritis involves the use of oral rehydration solutions (ORS) to prevent and treat dehydration.

• The primary therapeutic role of ORS solutions is in the prevention and treatment of dehydration during the management of acute gastroenteritis 2.
• Successful oral rehydration therapy involves early use of ORS with maintenance or timely resumption of regular feeding 2.

Comparison of Oral and Intravenous Rehydration

Studies have compared oral rehydration therapy (ORT) with intravenous rehydration therapy (IVT) in children with acute gastroenteritis.

• A systematic review found that ORT was associated with a higher risk of treatment failure, but IVT was associated with a higher risk of phlebitis and other complications 3.
• The review concluded that ORT is a safe and effective treatment for acute gastroenteritis in children, but IVT may be necessary in some cases 3.

Other Treatments for Gastroenteritis

Other treatments for gastroenteritis include:

• Enteral rehydration solutions, lactose-free feeds, and loperamide for the treatment of gastroenteritis 4.
• Ondansetron for the treatment of vomiting, which has been shown to be effective in reducing vomiting episodes in children with acute gastroenteritis 5.
• Oral rehydration solutions such as Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS) have been compared in adults with viral gastroenteritis, with no significant differences in efficacy or safety found between the three solutions 6.

Key Findings

Key findings from the studies include:

• The importance of early use of ORS in the treatment of acute gastroenteritis 2.
• The safety and efficacy of ORT in children with acute gastroenteritis 3.
• The potential benefits of ondansetron in reducing vomiting episodes in children with acute gastroenteritis 5.
• The equivalence of different oral rehydration solutions in adults with viral gastroenteritis 6.