What is the treatment for a stomach virus?

Treatment for Stomach Virus

The primary treatment for viral gastroenteritis is oral rehydration therapy, with continued normal feeding during illness to maintain gut integrity and resuming an age-appropriate usual diet during or immediately after rehydration. 1

Rehydration Therapy

• Oral Rehydration Solution (ORS) is the cornerstone of treatment for viral gastroenteritis 1
• For mild cases:
  • Half-strength apple juice followed by preferred liquids is effective 2
  • Commercial solutions like Pedialyte, Gatorade, or other oral rehydration solutions are all effective in correcting dehydration 3
• For moderate dehydration:
  • Formal oral rehydration solutions are recommended 2
• For severe dehydration:
  • Intravenous fluids may be necessary when patients cannot tolerate oral rehydration or have severe dehydration with signs of shock 2

Diet Management

• Continue normal feeding during illness 1
• Easily digestible foods (BRAT diet - bananas, rice, applesauce, toast) can be helpful during recovery 1
• Breast milk should be continued for infants, as it may have protective effects against viral enteric infection 1
• Be aware that mild lactose intolerance may develop after rotavirus infection (typically lasting 10-14 days) 1

Symptom Management

• Antiemetics:

  • Ondansetron may be considered when vomiting is severe and preventing adequate oral rehydration, particularly in children >4 years 1

• Antimotility Agents:

  • Should NOT be given to children <18 years with acute diarrhea 1
  • In adults, loperamide may be considered only after adequate hydration is achieved, but should be avoided with fever or inflammatory diarrhea 1

• Other Medications:

  • Bismuth subsalicylate may reduce the duration of Norwalk virus infection (from 27 to 20 hours) 1

Prevention of Transmission

• Vigorous handwashing with soap for at least 10 seconds after contact with ill persons 1, 4
• Clean soiled surfaces promptly with appropriate disinfectants 4, 1
• Isolate affected individuals for at least 2 days after symptom resolution 1
• Handle soiled linens with minimum agitation and launder promptly with detergent 4
• Food handlers should not prepare food for at least 2 days after resolution of illness 1

Special Considerations

High-Risk Patients

• Elderly patients are at higher risk for dehydration and electrolyte imbalances and may require closer monitoring 1
• Immunocompromised individuals may experience prolonged viral shedding and more severe disease, particularly with cytomegalovirus or adenovirus 1
  • For immunocompromised patients with CMV enteritis, ganciclovir treatment for 2-3 weeks (5 mg/kg bid IV), followed by maintenance therapy may be required 4
  • For adenovirus in severely ill immunocompromised patients, cidofovir may be considered despite its nephrotoxicity 4

Common Pitfalls to Avoid

1. Delaying rehydration - This is the most critical intervention and should be started immediately
2. Unnecessary dietary restrictions - Continuing normal feeding is recommended rather than fasting
3. Overuse of antimotility agents - These can prolong viral shedding and are contraindicated in children
4. Unnecessary antibiotic use - Antibiotics are ineffective against viral gastroenteritis and may worsen outcomes
5. Inadequate infection control measures - Strict hygiene is essential to prevent transmission

Duration of Illness

Most viral gastroenteritis cases are self-limiting, with symptoms typically lasting:

• Norovirus: 24-72 hours
• Astrovirus: 1-4 days
• Rotavirus: 4-7 days 1

Remember that viral shedding may continue for up to 3 weeks with norovirus, emphasizing the importance of continued hygiene measures even after symptoms resolve 1.