From the Guidelines
Treatment of norovirus diarrhea is primarily supportive, focusing on preventing dehydration through oral rehydration therapy. The most recent and highest quality study, 1, suggests that oral rehydration has been shown to be useful in all ages. Start with frequent small sips of oral rehydration solutions like Pedialyte, Gatorade, or homemade solutions (1 teaspoon salt, 8 teaspoons sugar in 1 liter of water). Adults should consume 2-3 liters daily, while children need 1 ml of fluid per gram of stool output.
Key Considerations
- No specific antiviral medications are approved for norovirus.
- Avoid anti-diarrheal medications like loperamide (Imodium) unless absolutely necessary, as they can prolong viral shedding, according to 1.
- Resume eating bland, easy-to-digest foods (bananas, rice, toast) once vomiting subsides.
- Strict hand hygiene with soap and water (not just alcohol-based sanitizers) and surface disinfection with bleach solutions (1000-5000 ppm) are essential to prevent transmission.
- Norovirus is highly contagious, and infected individuals should avoid preparing food for others and stay home from work or school until 48-72 hours after symptoms resolve.
Additional Guidance
- Symptoms typically last 24-72 hours, and most patients recover completely without specific treatment as the virus is self-limiting.
- The use of ondansetron, a serotonin 5-HT3 receptor antagonist, has been beneficial in reducing vomiting in children, but its use is not recommended for routine use in acute gastroenteritis in children <4 years of age or in adults, as stated in 1.
- Loperamide, a locally acting opioid receptor agonist, has been shown to reduce diarrhea prevalence and duration, but its use is not recommended unless absolutely necessary, due to the risk of adverse events, including ileus, abdominal distension, and lethargy, as reported in 1.
From the FDA Drug Label
Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).
The treatment for Norovirus-induced diarrhea with loperamide is symptomatic. Loperamide hydrochloride does not treat the underlying cause of the diarrhea, but rather helps to manage the symptoms. Specific treatment for the underlying cause of the diarrhea, in this case Norovirus, should be given when appropriate. 2
From the Research
Treatment Overview
The treatment for Norovirus-induced diarrhea is primarily focused on managing symptoms and preventing complications, as there is no specific antiviral therapy available.
- Correction of dehydration and maintenance of fluid status and nutrition are crucial in treating norovirus illness 3.
- Hand hygiene, exclusion of ill individuals, and environmental cleaning are important for norovirus outbreak prevention and control 3.
Symptomatic Relief
Some studies suggest that certain medications may help alleviate symptoms of norovirus-induced diarrhea:
- Ondansetron, a serotonin receptor antagonist, has been shown to reduce rotavirus symptoms, including vomiting and diarrhea, and may be beneficial in treating norovirus gastroenteritis as well 4.
- Other treatment strategies, such as nitazoxanide, ribavirin, and enterally administered immunoglobulin, have been suggested in case reports, but with varying results 5.
Special Considerations
Immunocompromised individuals are at risk for more severe outcomes and may require prolonged hospitalization and intensive supportive care:
- Norovirus gastroenteritis can last for several years in immunocompromised patients, leading to severe malnutrition, dehydration, electrolyte imbalance, and continuous viral shedding 5.
- Favipiravir has been suggested as a potential treatment, but it has not been tested on humans, highlighting the need for further research 5.