From the Guidelines
Treatment for enteritis in pediatric patients primarily focuses on preventing dehydration through oral rehydration therapy (ORT) using solutions like Pedialyte, Enfalyte, or WHO oral rehydration solution, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal is to prevent dehydration and reduce symptom duration. Children should continue their normal diet without restricting food, as early refeeding improves recovery. For mild to moderate dehydration, give 50-100 mL/kg of ORT over 3-4 hours; for severe cases, IV fluids may be necessary. Probiotics such as Lactobacillus GG (5-10 billion CFU/day) or Saccharomyces boulardii (250-500 mg twice daily) can reduce symptom duration. Zinc supplementation (10-20 mg daily for 10-14 days) is beneficial, especially in developing countries. Antiemetics like ondansetron (0.15 mg/kg/dose) may be used for persistent vomiting, particularly in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting 1. Some key points to consider in the treatment of enteritis in pediatric patients include:
- Antibiotics are generally avoided unless there's bacterial confirmation, bloody diarrhea, or immunocompromise.
- Antimotility drugs (eg, loperamide) should not be given to children <18 years of age with acute diarrhea 1.
- Parents should seek immediate medical attention if the child shows signs of severe dehydration (decreased urination, lethargy, dry mouth), persistent vomiting, bloody stools, or high fever, as these may indicate complications requiring more intensive management. Most cases resolve within 5-7 days with supportive care.
From the Research
Treatment Overview
The treatment for enteritis in pediatric patients typically involves oral rehydration therapy (ORT) and, in some cases, the use of anti-emetic medications to manage vomiting.
- Oral rehydration therapy is effective and successful in the majority of patients, as noted in the study 2.
- The use of anti-emetic medications, such as ondansetron, has been shown to facilitate ORT and minimize the risk of dehydration and the need for intravenous hydration and hospitalization 2.
Oral Rehydration Therapy (ORT)
ORT is an effective and inexpensive treatment for dehydration associated with gastroenteritis, as highlighted in the study 3.
- ORT can be used to treat children with mild to moderate dehydration, and it has been shown to reduce the need for hospitalization 4.
- However, ORT may not be suitable for all patients, and some may require intravenous rehydration therapy (IVT) instead 3.
Anti-Emetic Medications
Anti-emetic medications, such as ondansetron, can be used to manage vomiting in pediatric patients with enteritis.
- Ondansetron has been shown to be efficacious and superior to other anti-emetic medications in the treatment of gastroenteritis-related vomiting 2.
- The addition of ondansetron to an oral rehydration protocol has been shown to reduce the need for intravenous fluid administration and admissions in children with acute gastroenteritis 5.
Predictors of Outcomes
Certain clinical variables, such as large urinary ketones and altered mental status, can predict the need for intravenous fluid administration in pediatric patients with enteritis 6.
- Other predictors of outcomes, such as the number of episodes of vomiting and heart rate at discharge, can also be used to identify patients who are at risk of requiring further emergency department care 6.
Intravenous Rehydration Therapy (IVT)
IVT may be necessary for patients who are unable to tolerate oral fluids or who have severe dehydration.