What is the treatment for viral gastroenteritis?

Treatment of Viral Gastroenteritis

The cornerstone of treatment for viral gastroenteritis is oral rehydration therapy (ORT) using oral rehydration solution (ORS), which should be the first-line treatment for mild to moderate dehydration. 1

Rehydration Therapy

Mild to Moderate Dehydration

• Oral rehydration solution (ORS) is the first-line treatment, as recommended by both the CDC and WHO 1
• ORT is as effective as intravenous (IV) fluid therapy for rehydration in children with mild-to-moderate dehydration 2
• Reserve IV fluid therapy for:
  • Severe dehydration
  • Inability to tolerate oral fluids
  • Altered mental status
  • Shock 1

Electrolyte Monitoring

• Measurements of serum electrolytes, creatinine, and glucose are usually unnecessary
• Only consider laboratory tests in patients with severe dehydration requiring hospitalization and IV therapy 2

Nutritional Management

Feeding During Illness

• 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 1
• For infants, breastfeeding should continue as breast milk has protective effects against viral enteric infections 1

Dietary Considerations

• Although the BRAT diet (bananas, rice, applesauce, and toast) is commonly recommended, scientific evidence supporting this approach is limited 1
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice, Jell-O, presweetened cereals) as they can exacerbate diarrhea through osmotic effects 3
• For children under 5 years with acute diarrhea, a lactose-free diet may reduce duration of diarrhea by approximately 18 hours 1

Pharmacologic Therapy

Antiemetics

• Ondansetron may be given to facilitate oral rehydration in children >4 years and adolescents with vomiting 1
• Important timing: administer antiemetics only after adequate hydration has been established 1
• Benefits include reduced vomiting and decreased need for hospitalization, though it may increase stool volume 1

Antimotility Agents

• Antimotility drugs (e.g., loperamide) should NOT be given to children <18 years of age with acute diarrhea 1
• These agents may be considered for symptomatic relief in immunocompetent adults with acute watery diarrhea 1
• Avoid in all cases of inflammatory diarrhea or diarrhea with fever 1

Antimicrobial Therapy

• Antimicrobial agents have limited usefulness in viral gastroenteritis 3
• Since viral agents are the predominant cause of acute diarrhea, antimicrobial agents play only a limited role in management 3

Special Considerations

Age-Related Differences

• Children experience a higher proportion of vomiting
• Adults experience a higher proportion of diarrhea
• Elderly may experience more severe symptoms and prolonged duration 1

High-Risk Populations

• Immunocompromised individuals may experience:
  • Prolonged viral shedding
  • More severe disease
  • Longer symptom duration
  • Higher risk of complications 1
• Older adults and those with certain medical conditions are at higher risk for severe dehydration and electrolyte imbalances 1

Prevention Strategies

• Vigorous handwashing with soap and water for at least 20 seconds
• Use alcohol-based hand sanitizers (≥70% ethanol) as an adjunct
• Exclude ill staff from food service, childcare, and healthcare settings until 48-72 hours after symptom resolution
• Clean and disinfect contaminated surfaces with chlorine bleach solution or EPA-approved disinfectants 1
• Food handlers should not prepare food for at least 2 days after resolution of illness 1

Common Pitfalls to Avoid

1. Overreliance on IV fluids: ORT is as effective as IV therapy for mild to moderate dehydration and should be tried first 2
2. Prolonged fasting: Instructing patients to refrain from eating solid food for 24 hours does not appear to be useful 1
3. Using antimotility agents in children: These can lead to serious complications including opiate-induced ileus and may prolong viral shedding 3, 1
4. Unnecessary laboratory testing: Routine electrolyte testing is not needed except in severe cases 2
5. Inappropriate use of antibiotics: Since most cases are viral, antibiotics are generally not indicated 3