What is the treatment for gastroenteritis?

Treatment of Gastroenteritis

The mainstay of treatment for gastroenteritis is oral rehydration therapy with reduced osmolarity oral rehydration solution (ORS), with antimicrobial therapy generally not recommended for most cases of acute watery diarrhea. 1

Rehydration Therapy

Assessment of Dehydration

• Assess dehydration level:
  • Mild (3-5%): Increased thirst, slightly dry mucous membranes
  • Moderate (6-9%): Loss of skin turgor, dry mucous membranes
  • Severe (≥10%): Severe lethargy, altered consciousness 1

Treatment Algorithm

1. Mild to Moderate Dehydration:

   • First-line: Oral rehydration therapy with reduced osmolarity ORS 1, 2
   • Replace ongoing fluid losses with approximately 10 mL/kg ORS for each watery stool and 2 mL/kg ORS for each episode of vomiting 1
   • If vomiting persists, consider ondansetron (4 mg single dose) for children >4 years to facilitate oral rehydration 1
   • Nasogastric ORS administration may be considered for those who cannot tolerate oral intake 1

2. Severe Dehydration:

   • Administer isotonic IV fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 1
   • Transition to ORS once stabilized 1

Despite the slightly higher risk of treatment failure with ORS compared to IV therapy (1 in 25 patients may require transition to IV), the benefits of ORS include shorter hospital stays and avoidance of phlebitis risk associated with IV therapy 3.

Nutritional Management

• Continue breastfeeding throughout the diarrheal episode in infants and children 1
• Resume age-appropriate diet during or immediately after rehydration 1
• Recommended diet includes starches, cereals, yogurt, fruits, and vegetables 1
• Avoid foods high in simple sugars and fats 1

Antimicrobial Therapy

• Generally not recommended for most cases of acute watery diarrhea 1
• Consider antibiotics only in specific situations:
  • Immunocompromised patients with severe illness
  • Bloody diarrhea
  • Ill-appearing young infants
  • Patients with clinical features of sepsis or suspected enteric fever
  • Severe travelers' diarrhea (azithromycin preferred in children) 1

Symptomatic Treatment

• Antiemetics: Ondansetron (4 mg single dose) for children >4 years with vomiting to facilitate oral rehydration 1, 4

  • Note: Recent evidence supports single-dose ondansetron in emergency departments to reduce IV fluid administration and hospitalization rates; multiple doses or IV administration should be avoided 4

• Antidiarrheals:

  • Bismuth subsalicylate may be considered for children over 3 years and adults 1
  • Do not use loperamide in children under 18 years with acute diarrhea 1

• Probiotics: Recent large trials have demonstrated a lack of benefit, and routine use for gastroenteritis should be discouraged 4

Monitoring and Follow-up

• Monitor hydration status every 2-4 hours, especially in high-risk patients 1
• Daily weight monitoring is recommended 1
• Seek immediate medical attention for warning signs:
  • Bloody diarrhea
  • Persistent vomiting
  • Signs of severe dehydration
  • Altered mental status
  • High fever 1

Prevention and Infection Control

• Hand hygiene after using toilet, changing diapers, before/after food preparation, before eating, and after handling soiled items 1
• Thorough cleaning of environmental surfaces 1
• Safe food and water practices 1
• Proper handling of fecally contaminated materials 1

Special Considerations

• Zinc supplementation: Beneficial for children 6 months to 5 years in countries with high prevalence of zinc deficiency or with signs of malnutrition 1

• Vitamin A supplementation: For children 12 months to 5 years (200,000 UI every 3 months) and infants under 12 months (100,000 UI every 3 months) 1

The evidence strongly supports oral rehydration as the cornerstone of gastroenteritis treatment, with antimicrobial therapy reserved for specific situations. Proper assessment of dehydration and appropriate rehydration strategies are crucial for successful management.