What is the treatment for infectious gastroenteritis in a child?

From the Guidelines

The primary treatment for infectious gastroenteritis in children should focus on preventing dehydration through oral rehydration therapy, with medications like loperamide avoided due to potential serious side effects, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1, 2, 3, 4, 5. The treatment approach should prioritize oral rehydration solutions like Pedialyte, Infalyte, or homemade solutions, with the aim of preventing dehydration and supporting the child's recovery.

• For mild to moderate dehydration, give 50-100 mL/kg over 3-4 hours;
• for maintenance, provide 100 mL/kg/day for the first 10 kg of weight, plus 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day thereafter. Some key points to consider in the management of infectious gastroenteritis in children include:
• Continuing the child's regular diet without restricting food, as eating helps intestinal recovery 4.
• Avoiding sugary drinks, juices, and sodas which can worsen diarrhea.
• Antibiotics are only indicated for specific bacterial infections like Shigella, certain E. coli strains, or Campylobacter, and should be prescribed by a healthcare provider after appropriate testing 5.
• Anti-diarrheal medications like loperamide (Imodium) should be avoided in children as they can cause serious side effects, such as ileus, abdominal distension, and lethargy, particularly in children under 3 years old 2, 5.
• Probiotics such as Lactobacillus GG or Saccharomyces boulardii may help reduce the duration of symptoms by 1-2 days. It is essential to seek immediate medical attention if the child shows signs of severe dehydration, bloody diarrhea, persistent vomiting, high fever above 102°F (39°C), or if symptoms persist beyond 5-7 days.

From the Research

Treatment Options for Infectious Gastroenteritis in Children

• Oral rehydration therapy (ORT) is an effective and inexpensive treatment for dehydration associated with gastroenteritis in children, as shown in a study published in 2006 6.
• The use of oral rehydration solutions, such as ORS 200, is a good tool for oral rehydration in children of all ages with acute gastroenteritis, according to a study published in 2015 7.
• Treatment is primarily supportive and directed at preventing or treating dehydration, with oral rehydration therapy being the preferred approach for mild or moderate dehydration, as stated in a study published in 1999 8.

Comparison of Oral and Intravenous Rehydration

• A study published in 2006 found that there were more treatment failures with ORT, but the difference was not clinically significant, and the ORT group had shorter hospital stays 6.
• Another study published in 2004 found that the time required for intravenous rehydration was not significantly less than the time required for oral rehydration therapy, contrary to the perception of emergency physicians 9.
• A study published in 2010 found that oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous rehydration in most studies 10.

Use of Antiemetics and Other Medications

• The use of antiemetics, such as ondansetron, may be effective in decreasing the rate of vomiting and improving the success rate of oral hydration, according to a study published in 2010 10.
• However, the routine use of antiemetics in young children is generally not recommended, as stated in a study published in 2010 10.
• Antibiotics are not recommended for the treatment of gastroenteritis, except in certain cases, as stated in a study published in 1999 8.