What medications should be given in acute gastroenteritis?

Medication Management in Acute Gastroenteritis

For acute gastroenteritis, oral rehydration solution (ORS) is the first-line treatment for mild to moderate dehydration, with antimicrobial therapy (ciprofloxacin 500 mg twice daily for 5-7 days in adults) recommended for persistent cases lasting 14 days or more. 1

Rehydration Therapy

Mild to Moderate Dehydration

• First-line: Oral rehydration solution (ORS) containing 65-70 mEq/L sodium and 75-90 mmol/L glucose 1
  • Preparation: Mix 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water
• Continue age-appropriate diet during or immediately after rehydration
• For children, breastfeeding should be continued throughout rehydration 1

Severe Dehydration

• Isotonic intravenous fluids such as lactated Ringer's solution 1
• Once rehydrated, transition to ORS if tolerated 1
• Monitor electrolytes and acid-base status regularly 1

Pharmacological Management

Antimicrobial Therapy

• Indications:

  • Persistent watery diarrhea lasting ≥14 days 1
  • Severe cases with systemic symptoms

• For adults:

  • Ciprofloxacin 500 mg orally twice daily for 5-7 days 1, 2
  • Alternative: Azithromycin (depending on local susceptibility patterns) 1

• For children:

  • <3 months or with neurologic involvement: Third-generation cephalosporin
  • Other children: Azithromycin (based on local susceptibility) 1

Antiemetics

• Ondansetron can be considered when vomiting hinders oral rehydration 3, 4
• Benefits include:
  • Reduced need for IV fluids
  • Decreased hospitalization rates
  • Improved tolerance of oral rehydration 5, 3
• Single-dose administration is preferred; avoid multiple doses or IV administration 4

Nutritional Support

• Zinc supplementation for children 6 months to 5 years with malnutrition 1
• Probiotics are not routinely recommended based on recent evidence showing lack of benefit 4
• Dietary recommendations:
  • Bland/BRAT diet (Bananas, Rice, Applesauce, Toast) 1
  • Avoid spicy foods, coffee, alcohol, and foods high in simple sugars and fats 1

Important Considerations and Pitfalls

Avoid These Medications

• Antimotility agents in inflammatory diarrhea (can worsen outcomes) 1
• Routine use of probiotics (recent evidence shows lack of efficacy) 4
• Multiple doses of antiemetics 4

Warning Signs Requiring Immediate Attention

• Severe abdominal pain or distension
• Altered mental status
• Tachycardia, hypotension
• Signs of ileus or toxic megacolon 1

Follow-up

• Reassess after 48-72 hours of treatment
• Consider alternative diagnoses if no improvement occurs
• For persistent symptoms, reassess fluid/electrolyte balance and consider noninfectious causes (IBD, IBS, lactose intolerance) 1

Medication Administration Notes

• Ciprofloxacin should be administered at least 2 hours before or 6 hours after antacids, sucralfate, or products containing calcium, iron, or zinc 2
• Continue antimicrobial therapy for at least 2 days after symptoms resolve 2