What is the management of acute gastroenteritis in adults?

Management of Acute Gastroenteritis in Adults

Oral rehydration therapy (ORT) with reduced osmolarity solutions is the cornerstone of management for acute gastroenteritis in adults, supplemented with antimotility agents like loperamide for symptomatic relief when appropriate. 1

Initial Assessment and Rehydration

Rehydration Strategy

• First-line treatment: Oral rehydration solution (ORS) with reduced osmolarity (65-70 mEq/L sodium, 75-90 mmol/L glucose) 1
• Administration technique: Small amounts (5-15 mL) every 5-10 minutes using a small spoon or oral syringe 1
• Dosing for adults:
  • Mild dehydration: 50 mL/kg over 4 hours
  • Moderate dehydration: 100 mL/kg over 4 hours 1
• Commercial options: Products like Pedialyte are effective, but sports drinks like Gatorade may cause persistent hypokalemia 2

Dietary Management

• Early feeding is crucial - reduces stool output and duration of diarrhea by approximately 50% 1
• Resume normal diet immediately after rehydration 3
• Recommended foods: Bland/BRAT diet (Bananas, Rice, Applesauce, Toast) 1
• Foods to avoid: Spicy foods, coffee, alcohol, and foods high in simple sugars and fats 1

Pharmacological Management

Antimotility Agents

• Loperamide (recommended dosing):
  • Initial dose: 4 mg (two capsules)
  • Maintenance: 2 mg (one capsule) after each unformed stool
  • Maximum daily dose: 16 mg (eight capsules) 4
  • Clinical improvement usually observed within 48 hours 4

Antiemetics

• Ondansetron can enhance compliance with oral rehydration therapy and decrease hospitalization rates in cases with significant vomiting 5

Antimicrobial Therapy

• Not routinely recommended for most cases of acute watery diarrhea 1
• Consider only in specific situations:
  • Fever ≥38.5°C
  • Signs of sepsis
  • Bloody diarrhea with fever and abdominal pain
  • Recent international travel with fever 1
• When indicated: Adults may be treated with fluoroquinolone (e.g., ciprofloxacin) or azithromycin based on local susceptibility patterns 1

Probiotics

• Limited efficacy and availability for acute diarrhea in adults 3
• Not generally recommended as standard treatment

Special Considerations

When to Seek Medical Care

Medical intervention is recommended when:

• Patient is frail or elderly (>75 years)
• Concurrent chronic disease is present
• No improvement after 48 hours of self-treatment
• Signs of deterioration:
  • Dehydration
  • Abdominal distension
  • Fever >38.5°C
  • Bloody stools 3

Monitoring and Follow-up

• Regularly assess hydration status until corrected
• Track frequency of bowel movements
• Monitor for signs of improving hydration
• Reassess after 48-72 hours of treatment 1
• Consider alternative diagnoses if no improvement occurs

Prevention Measures

• Hand hygiene: Proper handwashing is essential
• Food and water safety: Education about safe food handling and water consumption
• Infection control: Implement measures to prevent spread to others 1

Treatment Algorithm

1. Assess dehydration severity
2. Begin oral rehydration therapy with reduced osmolarity solution
3. Add loperamide for symptomatic relief if no contraindications exist
4. Resume normal diet as soon as possible
5. Monitor response for 48 hours
6. Seek medical care if no improvement or if deterioration occurs

This evidence-based approach prioritizes rehydration while providing symptomatic relief, which addresses both the underlying physiological disturbance and improves quality of life during the illness.