What is the best medication for gastroenteritis?

From the Guidelines

For gastroenteritis, loperamide is the best medication to manage symptoms, as it reduces the duration and frequency of diarrhea, and is recommended for use in adults with acute watery diarrhea, as stated in the 2017 Infectious Diseases Society of America clinical practice guidelines 1.

Key Points to Consider

• Loperamide is a locally acting opioid receptor agonist that decreases the muscular tone and motility of the intestinal wall, making it effective in reducing diarrhea.
• The recommended dose of loperamide is 2 tablets (4 mg) initially, followed by 2 mg after each loose or liquid stool, with a maximum daily dose of 16 mg.
• Loperamide should be avoided in children under 18 years of age, and in patients with suspected or proven toxic megacolon, inflammatory diarrhea, or diarrhea with fever.
• Other medications, such as bismuth subsalicylate, may be used to manage symptoms, but loperamide is generally more effective.
• It is essential to stay hydrated by drinking clear fluids, such as water, broth, or commercial oral rehydration solutions like Pedialyte, taking small sips frequently.

Important Considerations

• Antibiotics are not effective against viral gastroenteritis and should only be used in cases of bacterial infection.
• Patients with severe symptoms, such as bloody diarrhea, high fever, or dehydration, should seek medical attention immediately.
• Loperamide may interact with other medications, such as antacids, and may worsen certain conditions, such as constipation.
• The use of loperamide in combination with antimicrobial agents, such as quinolones, may be effective in reducing the duration of diarrhea, but should be used with caution due to the risk of increasing antimicrobial resistance 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Loperamide hydrochloride capsules are contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions Acute Diarrhea Adults and Pediatric Patients 13 Years and Older: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool.

The best medication for gastroenteritis is not explicitly stated in the provided drug label. Loperamide is indicated for the treatment of acute diarrhea in adults and pediatric patients 13 years and older, but it is not specified as the best medication for gastroenteritis.

• The label provides dosage information for loperamide in the treatment of acute diarrhea, but it does not compare its effectiveness to other medications for gastroenteritis.
• The label also notes that patients should receive appropriate fluid and electrolyte replacement as needed, which is an important aspect of treating gastroenteritis, but it does not provide information on the best medication for this condition 2.

From the Research

Medication Options for Gastroenteritis

• Ondansetron and domperidone are two medications that have been studied for the treatment of gastroenteritis-associated vomiting in children 3, 4.
• Ondansetron has been shown to be more efficacious than domperidone in cessation of vomiting associated with acute gastroenteritis in children 3, 4.
• A study published in the Journal of Cureus found that ondansetron was more effective than domperidone in stopping vomiting in children with acute gastroenteritis, with 95% of children in the ondansetron group improving at 24 hours compared to 85% in the domperidone group 3.
• Another study published in PloS one found that ondansetron reduced the risk of intravenous rehydration by over 50% compared to both placebo and domperidone in children with gastroenteritis 4.

Efficacy of Ondansetron

• Ondansetron has been shown to be effective in reducing vomiting and facilitating oral rehydration in children with gastroenteritis 5, 6.
• A study published in the New England Journal of Medicine found that children who received ondansetron were less likely to vomit and had greater oral intake compared to those who received placebo 6.
• A study published in Annals of Emergency Medicine found that ondansetron facilitated oral rehydration therapy in children with acute gastritis or acute gastroenteritis who failed initial oral rehydration therapy 5.

Comparison to Other Medications

• Domperidone was not found to be effective for the symptomatic treatment of vomiting during acute gastroenteritis in a study published in PloS one 4.
• Ondansetron has been compared to other antiemetic medications, but the majority of studies have focused on its comparison to domperidone or placebo 3, 5, 6, 4.