What is the best treatment for norovirus infection?

Treatment for Norovirus Infection

The best treatment for norovirus infection is supportive care focused on preventing and treating dehydration through oral rehydration therapy, as there is no specific antiviral treatment available. 1

Understanding Norovirus

Norovirus is a highly contagious viral infection that causes acute gastroenteritis with symptoms including:

• Vomiting
• Diarrhea
• Nausea
• Abdominal pain

In most healthy individuals, symptoms typically resolve without specific treatment after 1-3 days, though illness can last 4-6 days in young children, elderly persons, and hospitalized patients 2, 1.

Treatment Algorithm

1. Rehydration (Primary Treatment)

• Oral rehydration therapy is the cornerstone of treatment for most patients 1

  • Use oral rehydration solutions containing appropriate electrolytes
  • Encourage frequent small sips of fluid
  • Sports drinks diluted with water can be used for mild cases in adults

• Intravenous fluid therapy for:

  • Severe dehydration
  • Inability to tolerate oral fluids
  • High-risk patients (elderly, very young, immunocompromised) with significant fluid losses 1

2. Symptom Management

• Anti-emetics may be considered for severe vomiting 1
• Avoid anti-diarrheal medications in most cases, especially in children 1
• Monitor electrolyte balance particularly in vulnerable populations 1

3. Nutritional Support

• Resume normal diet as soon as tolerated
• Start with bland, easy-to-digest foods once vomiting subsides
• Avoid dairy products, caffeine, alcohol, and high-fat foods initially

Special Population Considerations

Immunocompromised Patients

Immunocompromised individuals may experience prolonged illness lasting weeks to years with potential complications including:

• Villous atrophy
• Severe malnutrition
• Continuous viral shedding 3

For these patients, experimental treatments have been reported in case studies:

• Nitazoxanide
• Ribavirin
• Enterally administered immunoglobulin 3

However, these treatments have shown variable results and are not part of standard guidelines.

Elderly Patients

• More susceptible to dehydration
• May require more aggressive fluid management
• At higher risk for mortality, particularly in long-term care facilities 1

Children

• Careful monitoring for dehydration signs
• Appropriate weight-based fluid replacement
• Early oral rehydration is critical 4

Prevention and Infection Control

While not directly part of treatment, prevention is crucial to limit spread:

• Hand hygiene: Proper handwashing with soap and running water for at least 20 seconds is most effective 2, 1

  • Alcohol-based hand sanitizers (≥70% ethanol) can be used as an adjunct but are not a substitute for handwashing

• Environmental cleaning: After removing soiling, disinfect surfaces using:

  • Chlorine bleach solution (1,000-5,000 ppm concentration)
  • EPA-approved disinfectants with norovirus claims 2, 1

• Isolation measures:

  • Exclude ill staff in food service, childcare, and healthcare settings until 48-72 hours after symptom resolution
  • Isolate ill residents/patients until 24-48 hours after symptom resolution 2, 1

Common Pitfalls to Avoid

1. Inadequate rehydration: Underestimating fluid losses can lead to severe dehydration
2. Premature return to work/school: Returning before 48-72 hours after symptom resolution can spread infection
3. Ineffective disinfection: Using products without proven efficacy against norovirus
4. Overreliance on hand sanitizers: These are less effective than proper handwashing with soap and water
5. Inappropriate use of antibiotics: Antibiotics are ineffective against viral infections

Remember that norovirus is extremely contagious, with an infectious dose as low as 18 viral particles 2, making proper infection control measures essential to prevent outbreaks.