What is the treatment for viral gastroenteritis?

Treatment of Viral Gastroenteritis

The cornerstone treatment for viral gastroenteritis is oral rehydration therapy (ORT) using oral rehydration solution (ORS) to replace fluid and electrolyte losses, as recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). 1

Understanding Viral Gastroenteritis

Viral gastroenteritis typically presents with:

• Nausea (79%)
• Abdominal cramps (71%)
• Vomiting (69%)
• Non-bloody diarrhea (66%)

Duration varies by pathogen:

• Norwalk-like viruses: 12-60 hours
• Other viral pathogens: up to 7 days 1

Treatment Algorithm

1. Rehydration Therapy

• First-line: Oral Rehydration Therapy (ORT)

  • Effective for mild to moderate dehydration
  • As effective as IV therapy for most cases 1, 2
  • Administer ORS containing physiological concentrations of glucose and electrolytes 3

• Reserve IV fluid therapy for:

  • Severe dehydration
  • Inability to tolerate oral fluids
  • Altered mental status
  • Shock 1

2. Anti-emetic Therapy

• Ondansetron may be given to:
  • Children >4 years and adolescents with significant vomiting
  • Facilitate tolerance of oral rehydration
  • Reduce need for hospitalization 1, 4
  • Note: May increase stool volume 1

3. Nutritional Management

• Continue normal feeding during illness
• Resume age-appropriate diet during or immediately after rehydration
• Breast milk has protective effects and infants can usually be "fed through" an episode 1
• Avoid foods high in simple sugars as they can worsen diarrhea through osmotic effects 1

4. Symptomatic Relief

• For adults only: Loperamide may be given to immunocompetent adults with acute watery diarrhea 1
• Avoid antimotility drugs in:
  • Children <18 years of age
  • Cases with fever
  • Inflammatory diarrhea
  • Conditions where toxic megacolon may result 1

Special Considerations

Age-Specific Differences

• Children: Experience higher proportion of vomiting
• Adults: Experience higher proportion of diarrhea
• Elderly: May experience more severe symptoms and prolonged duration 1

High-Risk Populations

• Immunocompromised individuals:

  • Prolonged viral shedding
  • More severe disease
  • Longer symptom duration
  • Higher risk of complications 1

• Older adults and those with certain medical conditions:

  • Higher risk for severe dehydration
  • Electrolyte imbalances
  • Prolonged constitutional symptoms 1

Prevention Measures

• Vigorous handwashing with soap and water for at least 20 seconds
• Alcohol-based hand sanitizers (≥70% ethanol) as an adjunct
• Food handlers should not prepare food for at least 2 days after resolution of illness
• Exclusion of ill staff from food service, childcare, and healthcare settings until 48-72 hours after symptom resolution 1

Common Pitfalls to Avoid

1. Unnecessary laboratory testing: Measurements of serum electrolytes, creatinine, and glucose are usually not necessary except in severe dehydration requiring hospitalization 3

2. Inappropriate antibiotic use: Antimicrobial agents have limited usefulness in viral gastroenteritis and are not indicated 1

3. Premature discontinuation of feeding: Continuing normal feeding helps decrease intestinal permeability, reduce illness duration, and improve nutritional outcomes 1

4. Overreliance on IV fluids: ORT is as effective as IV therapy for mild to moderate dehydration and should be tried first 1, 2

5. Inappropriate use of antimotility agents in children: These should be avoided in children <18 years of age 1