What is the treatment for viral gastroenteritis?

Treatment of Viral Gastroenteritis

Oral rehydration therapy (ORT) using oral rehydration solution (ORS) is the first-line treatment for viral gastroenteritis, as recommended by the CDC and WHO. 1

Clinical Presentation

Viral gastroenteritis typically presents with:

• Nausea (79%)
• Abdominal cramps (71%)
• Vomiting (69%)
• Non-bloody diarrhea (66%)
• Additional symptoms: headache (50%), fever (37%), chills (32%), myalgias (26%), and sore throat (18%) 1

Duration varies by pathogen:

• Norovirus: 24-72 hours
• Rotavirus: 4-7 days
• Astrovirus: 1-4 days
• Adenovirus: ≥1 week 1

Treatment Algorithm

1. Rehydration

• First-line: Oral rehydration therapy (ORT) using oral rehydration solution 1, 2

  • As effective as IV therapy for mild-to-moderate dehydration 2
  • Takes advantage of remaining intact absorptive cells in the intestine 3

• Reserve intravenous (IV) fluid therapy for:

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

2. Antiemetic Therapy

• Ondansetron may be given to children >4 years and adolescents with vomiting to facilitate oral rehydration 1
  • Can increase success rate of oral rehydration therapy
  • May minimize need for IV therapy and hospitalization 2

3. Diet Management

• Continue normal feeding during illness
• Resume age-appropriate usual diet during or immediately after rehydration 1
• For infants: Continue breastfeeding (has protective effects against viral enteric infections) 1
• Avoid foods high in simple sugars (can exacerbate diarrhea through osmotic effects) 1

4. Antidiarrheal Medications

• For adults: Loperamide may be given to immunocompetent adults with acute watery diarrhea 1
• For children: Antimotility drugs should NOT be given to children <18 years with acute diarrhea 1
• Contraindications: Avoid antimotility agents in cases of inflammatory diarrhea, diarrhea with fever, or when toxic megacolon may result 1

Special Considerations

Electrolyte Monitoring

• Serum electrolytes measurement generally unnecessary except in severe dehydration requiring hospitalization 2
• Monitor for hypokalemia and hyponatremia, particularly when using sports drinks like Gatorade for rehydration 4

High-Risk Populations

• Immunocompromised individuals: May experience prolonged viral shedding, more severe disease, longer symptom duration, and higher risk of complications 1
• Elderly: May experience more severe symptoms, prolonged duration, and higher risk of dehydration and electrolyte imbalances 1

Prevention

• 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
• Cleaning and disinfection of contaminated surfaces with chlorine bleach solution or EPA-approved disinfectants 1
• Rotavirus vaccination for prevention of rotavirus gastroenteritis 5, 2

Common Pitfalls to Avoid

1. Overreliance on IV fluids: ORT is as effective as IV therapy for mild-to-moderate dehydration and should be first-line treatment 2

2. Unnecessary laboratory testing: Measurements of serum electrolytes, creatinine, and glucose are usually not necessary except in severe cases 2

3. Inappropriate use of antimotility drugs in children: These should be avoided in children <18 years 1

4. Dietary restrictions: Continuing normal feeding during illness improves outcomes; fasting or "resting the gut" is not recommended 1

5. Using inappropriate rehydration solutions: Sports drinks like Gatorade may lead to persistent hypokalemia compared to medical oral rehydration solutions 4