What is the treatment for gastroenteritis?

Gastroenteritis Treatment

The primary treatment for gastroenteritis is oral rehydration therapy (ORT) using low-osmolarity oral rehydration solutions (ORS), with early reintroduction of normal diet and selective use of medications for symptom management. 1

Rehydration Therapy

Oral Rehydration

• First-line treatment: Low-osmolarity ORS is the preferred method for rehydration 1
• Commercial ORS options include Pedialyte, CeraLyte, and Enfalac Lytren 1
• For mild dehydration in children, half-strength apple juice followed by preferred liquids can be effective 2
• Nasogastric administration should be considered for patients who cannot tolerate oral intake or are too weak to drink adequately 1

Intravenous Rehydration

• Reserved for specific situations:
  • Severe dehydration
  • Shock
  • Altered mental status
  • Failure of ORT
  • Ileus 1
• Use isotonic fluids such as lactated Ringer's or normal saline 1
• Transition to ORT once the patient is stabilized 1

Nutritional Management

• Early feeding is critical - reduces stool output and duration of diarrhea by approximately 50% compared to gradual reintroduction of food 1
• Breastfeeding should be continued throughout the diarrheal episode in infants 1
• Resume regular, age-appropriate diet during or immediately after rehydration 1
• A bland diet (BRAT - bananas, rice, applesauce, toast) is recommended 1
• Avoid foods high in simple sugars and high-fat foods during rehydration 1

Medication Management

Anti-emetics

• Ondansetron may be used to prevent vomiting and improve ORS tolerance 1, 3
• Particularly helpful when vomiting hinders successful oral rehydration 3, 2
• Shown to reduce gastroenteritis-related vomiting and facilitate ORT without significant adverse events 3

Antimotility Drugs

• Do not give antimotility drugs (e.g., loperamide) to children under 18 years with acute diarrhea 1

Antibiotics

• Generally not indicated for most cases of acute gastroenteritis 1
• Empiric antimicrobial therapy is only recommended in specific cases:
  • Infants <3 months with suspected bacterial etiology
  • Immunocompetent patients with fever, abdominal pain, and bloody diarrhea
  • Recent international travelers with fever ≥38.5°C or signs of sepsis 1

Probiotics

• The American Gastroenterological Association suggests against probiotic use in children with acute infectious gastroenteritis in North America (conditional recommendation, moderate quality evidence) 1

Monitoring and Follow-up

• Monitor urine output (target ≥0.5 ml/kg/h)
• Track vital signs, especially blood pressure and heart rate
• Monitor electrolytes, particularly sodium levels 1

Warning Signs Requiring Immediate Medical Attention

• Persistent vomiting preventing ORS intake
• High stool output (>10 mL/kg/hour)
• Bloody diarrhea
• Worsening dehydration despite treatment
• Lethargy or altered mental status 1

Prevention

• Proper hand hygiene
• Food and water safety
• Infection control measures 1
• Rotavirus vaccination significantly reduces gastroenteritis-related hospitalizations 1
• Asymptomatic contacts should not receive empiric treatment but should be advised on infection prevention measures 1

Special Considerations

• In adults, various rehydration solutions (including sports drinks like Gatorade) may be effective, though electrolyte imbalances (particularly hypokalemia) may persist with some commercial sports drinks 4
• Hospitalization and intravenous fluids are recommended for patients who do not respond to oral rehydration therapy plus an antiemetic and for those with severe dehydration 2
• Postinfectious complications can include irritable bowel syndrome and lactose intolerance 5