What is the treatment for viral gastroenteritis?

Treatment of Viral Gastroenteritis

The cornerstone of treatment for viral gastroenteritis is oral rehydration therapy (ORT) to replace fluid and electrolyte losses, with continuation of normal feeding during illness. 1

Rehydration Strategies

Oral Rehydration

• Oral rehydration solution (ORS) is the first-line treatment for mild to moderate dehydration 1, 2
• ORT is as effective as intravenous (IV) fluid therapy for rehydration in children with mild-to-moderate dehydration 3
• For every 25 children treated with ORT, one may fail and require IV therapy 3

Intravenous Rehydration

• Reserve for patients with:
  • Severe dehydration
  • Inability to tolerate oral fluids due to persistent vomiting
  • Altered mental status
  • Shock 2, 1

Nutritional Management

• Continue normal feeding during illness and resume age-appropriate usual diet during or immediately after rehydration 1
• Early refeeding decreases intestinal permeability, reduces illness duration, and improves nutritional outcomes 2
• Although the BRAT (bananas, rice, applesauce, and toast) diet is commonly recommended, supporting data for this intervention are limited 2
• Instructing patients to refrain from eating solid food for 24 hours does not appear to be useful 2
• For children under 5 years with acute diarrhea, a lactose-free diet may reduce duration of diarrhea by approximately 18 hours and reduce treatment failure by half 2

Pharmacological Management

Antiemetics

• Ondansetron may be given to facilitate tolerance of oral rehydration in children >4 years of age and adolescents with acute gastroenteritis associated with vomiting 2, 1
• Ondansetron can reduce vomiting in children and reduce the need for hospitalization for rehydration, although it may increase stool volume 2
• Timing is important: administer antiemetics only after adequate hydration has been established 2

Antimotility Agents

• Antimotility drugs (e.g., loperamide) should not be given to children <18 years of age with acute diarrhea 2, 1
• Loperamide may be given to immunocompetent adults with acute watery diarrhea 2
• Avoid antimotility agents at any age in suspected or proven cases where toxic megacolon may result in inflammatory diarrhea or diarrhea with fever 2

Probiotics

• Some strains of probiotics (e.g., Lactobacillus casei GG, Lactobacillus reuteri, and Saccharomyces boulardii) may reduce the duration of viral gastroenteritis by approximately 24 hours 4
• The clinical relevance of this finding is limited, but may provide some benefit, particularly in viral gastroenteritis 4

Special Considerations

Children

• Experience a higher proportion of vomiting compared to adults 1
• Require careful monitoring for dehydration
• Breast milk has protective effects against viral enteric infections, and infants can usually be "fed through" an episode 1

Adults

• Experience a higher proportion of diarrhea compared to vomiting 1
• Loperamide may be considered for symptomatic relief if no contraindications exist 2

Elderly and Immunocompromised

• At higher risk for severe dehydration and electrolyte imbalances 1
• May experience prolonged symptoms and viral shedding 1
• May require more aggressive hydration and monitoring

Prevention Strategies

• Vigorous handwashing with soap and water for at least 20 seconds 1
• Alcohol-based hand sanitizers (≥70% ethanol) as an adjunct 1
• Food handlers should not prepare food for at least 2 days after resolution of illness 1
• Cleaning and disinfection of contaminated surfaces with chlorine bleach solution or EPA-approved disinfectants 1

Common Pitfalls to Avoid

1. Delaying rehydration: Start ORT immediately upon diagnosis
2. Prescribing antimotility agents to children: These are contraindicated in children <18 years
3. Withholding food: Early refeeding improves outcomes
4. Overreliance on IV fluids: ORT is equally effective for mild to moderate dehydration
5. Neglecting prevention strategies: Proper hygiene practices are essential to prevent spread

Viral gastroenteritis is typically self-limiting, with symptoms usually lasting 12-60 hours for Norwalk-like viruses and up to 7 days for other viral pathogens 1. With appropriate rehydration and supportive care, most patients recover completely without complications.