How to manage Norovirus-induced diarrhea?

From the Guidelines

To manage Norovirus-induced diarrhea, focus on managing symptoms while your body fights the infection, as there is no specific medication that kills the virus, and prioritize hand hygiene, hydration, and rest. The most recent and highest quality study, 1, published in 2017, provides guidelines for the diagnosis and management of infectious diarrhea, including Norovirus. According to these guidelines, hand hygiene should be performed after using the toilet, changing diapers, before and after preparing food, before eating, after handling garbage or soiled laundry items, and after touching animals or their feces or environments, especially in public settings such as petting zoos.

Some key points to consider when managing Norovirus-induced diarrhea include:

• Staying well-hydrated by drinking plenty of clear fluids like water, diluted fruit juices, or oral rehydration solutions such as Pedialyte to replace lost fluids and electrolytes, as recommended by 1 and 1
• Adults can take over-the-counter anti-diarrheal medications like loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol) following package instructions, but these should be avoided in children or if you have bloody diarrhea or high fever, as suggested by 1 and 1
• Resting as much as possible and eating bland, easy-to-digest foods like bananas, rice, applesauce, toast, and crackers once you can tolerate food
• Norovirus is highly contagious, so washing your hands frequently with soap and water for at least 20 seconds, cleaning contaminated surfaces with bleach-based disinfectants, and avoiding preparing food for others while sick and for two days after symptoms resolve, as emphasized by 1, 1, and 1
• Seeking medical attention if you experience severe dehydration (extreme thirst, dry mouth, little or no urination, severe weakness), bloody stools, or if symptoms persist beyond three days, as recommended by 1 and 1

It is essential to note that the guidelines and recommendations provided are based on the most recent and highest quality study available, 1, and should be prioritized when managing Norovirus-induced diarrhea.

From the FDA Drug Label

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. Pediatric Patients 2 Years to 12 Years of Age: In pediatric patients 2 years to 5 years of age (20 kg or less), the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) should be used; for ages 6 to 12, either loperamide hydrochloride capsules or Imodium A-D liquid may be used

The management of Norovirus-induced diarrhea with loperamide involves:

• For adults and pediatric patients 13 years and older: an initial dose of 4 mg followed by 2 mg after each unformed stool.
• For pediatric patients 2 to 12 years of age:
  • 2 to 5 years (13 to 20 kg): 1 mg three times daily
  • 6 to 8 years (20 to 30 kg): 2 mg twice daily
  • 8 to 12 years (greater than 30kg): 2 mg three times daily The maximum daily dose is 16 mg. 2

From the Research

Management of Norovirus-Induced Diarrhea

• The primary approach to managing Norovirus-induced diarrhea involves oral or intravenous rehydration to compensate for water and electrolyte losses 3.
• Oral rehydration solutions, which contain glucose or glucose polymers and sodium, as well as other electrolytes, are effective in replacing fluids and electrolytes 4, 5.
• In addition to oral rehydration, attention to early feeding and encouragement of breast feeding can also be beneficial 4.
• Various modifications to the standard oral rehydration solution have been derived, including hypo-osmolar or hyperosmolar solutions, use of rice-based oral rehydration solutions, zinc supplementation, and the use of amino acids 5.
• For adults with viral gastroenteritis, including Norovirus-induced diarrhea, oral rehydration solutions such as Pedialyte, Gatorade, or a New Oral Rehydration Solution (N-ORS) can be effective in correcting dehydration and improving bowel symptoms 6.
• However, the development of specific antiviral countermeasures for Norovirus infections is still an area of ongoing research, with potential applications in immunocompromised patients and in the setting of acute outbreaks 7.

Treatment Options

• Oral rehydration solutions are the primary treatment for Norovirus-induced diarrhea, with the goal of replacing fluids and electrolytes lost due to diarrhea 3, 4, 5.
• Loperamide may be used as an antidiarrheal drug in some cases, but its use is not recommended for invasive diarrhea 3.
• Antibiotics are not typically used to treat Norovirus-induced diarrhea, as they are not effective against viral infections 3, 4.
• In severe cases or in immunocompromised patients, hospitalization and supportive care may be necessary to manage dehydration and other complications 7.