From the Guidelines
Gastroenteritis treatment should focus primarily on preventing dehydration with oral rehydration solutions, such as Pedialyte, as the cornerstone of treatment. The goal is to prevent dehydration while the infection runs its course. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, oral rehydration is recommended as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause.
Key Recommendations
- Adults should consume 2-3 liters of oral rehydration solution daily, while children need 1 ml of fluid per gram of stool output 1.
- Start with small sips every 5-10 minutes if vomiting is present.
- Anti-diarrheal medications like loperamide (Imodium) can help reduce symptoms in adults, but should be avoided in children and cases with bloody diarrhea or high fever 1.
- Antiemetics such as ondansetron 4-8mg every 8 hours can manage severe vomiting, especially in children >4 years of age and adolescents with acute gastroenteritis associated with vomiting 1.
- Resume eating with bland, easy-to-digest foods (bananas, rice, applesauce, toast) once able to tolerate fluids.
Important Considerations
- Most cases resolve within 3-5 days without antibiotics, as they're typically caused by viruses.
- Antibiotics are only indicated for specific bacterial causes like Shigella or severe Campylobacter infections.
- Hand washing and food safety practices help prevent spread to others.
- Seek medical attention if symptoms include severe dehydration, bloody stools, persistent vomiting, high fever above 102°F (39°C), or symptoms lasting more than 5 days.
Treatment Approach
- For mild to moderate dehydration, oral rehydration solutions are recommended, with the option of nasogastric administration if necessary 1.
- For severe dehydration, intravenous isotonic crystalloid boluses may be necessary until pulse, perfusion, and mental status return to normal, followed by oral rehydration solutions to replace ongoing losses 1.
From the Research
Treatment Options for Gastroenteritis
- The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis is oral rehydration solution 2.
- Antiemetics can be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 2.
- For patients with severe dehydration and hypoglycemia, more intensive treatment may be necessary 2.
Oral Rehydration Solutions
- The World Health Organization recommended formulation of oral rehydration salts is effective for replacing fluids and electrolytes, but may not reduce stool volume, frequency, or symptom duration 3.
- Modifications to the original formula, such as low osmolarity, rice-based, glucose polymers, and the addition of probiotics, prebiotics, and/or zinc, may increase tolerability and shorten the duration of diarrhea 3.
- Oral rehydration therapy with a rehydration solution can be used to treat diarrhea in children with mild to moderate dehydration 4.
Additional Treatment Options
- Ondansetron can decrease vomiting or help avoid the need for intravenous fluid, but may increase episodes of diarrhea 4.
- Probiotics can be used to shorten the course of diarrhea 4.
- A child's regular diet can be continued, as it may reduce the duration of diarrhea 4.
- Good handwashing can reduce the incidence of acute gastroenteritis, and rotavirus vaccines can significantly reduce the incidence of rotavirus gastroenteritis 4.
Efficacy of Oral Rehydration Solutions
- The efficacy of oral rehydration solutions has been enhanced by reducing osmolarity 5.
- Newer formulations of oral rehydration solutions are under investigation, with promise of added benefits, including promotion of intestinal healing 5.
- A randomized, controlled trial found that Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS) were effective in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 6.