From the Guidelines
The primary treatment for gastroenteritis is oral rehydration therapy with a reduced osmolarity oral rehydration solution (ORS), which is recommended as the first-line therapy for mild to moderate dehydration in infants, children, and adults. According to the 2017 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, reduced ORS is the preferred treatment for mild to moderate dehydration. The guidelines recommend administering ORS in the following amounts: 50–100 mL/kg over 3–4 hours for infants and children, and 2–4 L for adolescents and adults (≥30 kg) 1.
Key points to consider in the treatment of gastroenteritis include:
- The use of oral rehydration solutions like Pedialyte or CeraLyte, which are safe for all age groups and can be used in the presence of hypernatremia or hyponatremia 1
- The administration of ORS until clinical dehydration is corrected, and then maintenance fluids should be administered to replace ongoing losses 1
- The importance of continued breastfeeding in breastfed infants throughout the illness 1
- The use of isotonic intravenous fluids, such as lactated Ringer’s and normal saline solution, in cases of severe dehydration, shock, or altered mental status, and failure of ORS therapy 1
It is essential to note that antibiotics are not generally needed unless a bacterial infection is confirmed, and over-the-counter medications like loperamide and bismuth subsalicylate may be used to control diarrhea in adults, but should be avoided in children and cases with bloody diarrhea or high fever. Rest and hydration are crucial, and most cases of gastroenteritis resolve within 1-3 days. If symptoms persist or worsen, medical attention should be sought.
From the Research
Treatment for Gastroenteritis
The treatment for gastroenteritis typically involves oral rehydration solution, which is the mainstay of treatment for mild-to-moderately dehydrated patients 2. This approach is supported by various studies, including a review of oral rehydration solutions for treating dehydration due to gastroenteritis in children, which found that oral rehydration is an effective and inexpensive treatment 3.
Oral Rehydration Solution
Oral rehydration solution is recommended by the World Health Organization as the intervention of choice for the treatment of acute gastroenteritis 4. The solution helps replace fluids and electrolytes, but does not reduce stool volume, frequency, or symptom duration. Several modifications to the original formula have been proposed to increase tolerability, shorten the duration of diarrhea, and improve parental quality of life.
Comparison of Oral and Intravenous Rehydration
A study comparing oral with intravenous therapy for treating dehydration due to acute gastroenteritis in children found that oral rehydration therapy had a higher risk of paralytic ileus, but resulted in shorter hospital stays 3. Another study found that the time required for intravenous rehydration exceeded the 4-hour period recommended for oral rehydration, contradicting the perception that intravenous hydration is faster 5.
Key Points
- Oral rehydration solution is the mainstay of treatment for mild-to-moderately dehydrated patients with gastroenteritis 2
- Oral rehydration therapy is an effective and inexpensive treatment for dehydration due to gastroenteritis in children 3
- Modifications to the original oral rehydration solution formula have been proposed to improve tolerability and efficacy 4
- Intravenous rehydration therapy has a higher risk of complications, such as phlebitis, and may not be faster than oral rehydration therapy 3, 5
- Successful oral rehydration therapy involves early use of oral rehydration solution with maintenance or timely resumption of regular feeding 6