Treatment of Uncomplicated Gastroenteritis
For uncomplicated gastroenteritis, the mainstay of treatment is oral rehydration therapy without antimicrobial agents, as most cases are self-limited viral infections that resolve within a few days. 1, 2
Assessment of Hydration Status
- Evaluate recent fluid intake and output history - significant dehydration is unlikely if there is no decrease in oral intake or urine output and no vomiting 2
- Physical examination is the best way to evaluate hydration status - the four-item Clinical Dehydration Scale can help determine severity 2
- Signs of severe dehydration requiring immediate intervention include signs of shock or >10% dehydration 2
Treatment Approach Based on Severity
Mild Gastroenteritis
- Manage at home with oral rehydration therapy 2
- Half-strength apple juice followed by the child's preferred liquids is as effective as intravenous rehydration for preventing hospitalization 2
- Stool microbiological tests are not routinely needed when viral gastroenteritis is the likely diagnosis 2
Moderate Dehydration
- Oral rehydration solutions are recommended 2
- Ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 2
Severe Dehydration
- Hospitalization and intravenous fluids are recommended for patients who do not respond to oral rehydration therapy plus an antiemetic 2
- Intravenous hydration is necessary for those with severe illness who cannot tolerate oral fluids 1
Symptomatic Treatment
- Antiemetic drugs can be used for symptom control in cases with significant vomiting 1
- Antimotility agents may provide symptomatic relief but should be used cautiously 1
- Antisecretory medications can help reduce fluid loss in the intestines 1
When to Consider Antimicrobial Therapy
Antimicrobial therapy is generally NOT indicated for uncomplicated gastroenteritis but should be considered in specific situations:
- Clostridioides difficile infections (especially with recent antibiotic exposure) 1
- Travel-related diarrhea 1
- Bacterial infections with severe symptoms 1
- Parasitic infections 1
- Immunocompromised patients 3
Prevention Strategies
- Handwashing is crucial for reducing transmission 2
- Breastfeeding provides protective factors against gastroenteritis in infants 2
- Rotavirus vaccination has reduced infections by up to 90% in children 1
Complications to Monitor
- Approximately 9% of patients with acute gastroenteritis develop post-infectious irritable bowel syndrome 1
- Post-infectious lactose intolerance may occur temporarily 1
- Persistent symptoms beyond 5-7 days warrant further diagnostic investigation 3
Special Considerations
- In immunocompromised patients, a more aggressive diagnostic and treatment approach may be necessary 3
- For patients with bloody diarrhea, microbial studies are warranted to rule out invasive pathogens 1
- Avoid antibiotics in suspected STEC (Shiga toxin-producing E. coli) infections as they may increase the risk of hemolytic uremic syndrome 3