From the Guidelines
Viral gastroenteritis is primarily treated with supportive care, focusing on preventing dehydration through adequate fluid intake, and most cases resolve within 1-3 days without the need for antibiotics. The diagnosis of viral gastroenteritis is based on clinical presentation, which typically includes diarrhea, vomiting, abdominal cramps, and sometimes fever [ 1 ]. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea, laboratory investigation is generally not warranted for previously healthy, immunocompetent individuals with acute diarrhea, as most episodes are self-resolving and of viral or unknown etiology [ 1 ].
Key Treatment Principles
- Adults should consume clear liquids like water, broth, or oral rehydration solutions such as Pedialyte to prevent dehydration.
- A homemade oral rehydration solution can be made with 1 teaspoon salt and 8 teaspoons sugar in 1 liter of water.
- Small, frequent sips (every 5-10 minutes) are recommended if vomiting is severe.
- Once liquids are tolerated, bland foods like bananas, rice, applesauce, and toast (BRAT diet) can be gradually reintroduced.
- Over-the-counter medications such as loperamide (Imodium) can help control diarrhea in adults but should be avoided in children and if there's blood in stool or high fever [ 1 ].
- Acetaminophen can manage fever and discomfort, but NSAIDs should be avoided as they may irritate the stomach.
Prevention and Complications
- Frequent handwashing and proper food handling are essential preventive measures to reduce the spread of viral gastroenteritis [ 1 ].
- Individuals with diarrhea should refrain from recreational water activities, food preparation or service, and sexual activities while symptomatic.
- Specific preventive measures include routine use of rotavirus vaccine in infants and typhoid and cholera vaccines for travelers when indicated [ 1 ].
- Seek medical attention if experiencing severe dehydration, bloody diarrhea, persistent vomiting, high fever, or symptoms lasting more than 3 days.
Outcome-Based Considerations
- The primary goal of treatment is to prevent dehydration and manage symptoms, as most cases of viral gastroenteritis resolve on their own within 1-3 days.
- Reducing the risk of complications, such as dehydration and electrolyte imbalances, is crucial to improving morbidity, mortality, and quality of life outcomes.
- Appropriate use of antimicrobial agents and antimotility drugs is essential to avoid increasing resistance and worsening illness [ 1 ].
From the Research
Diagnosis of Viral Gastroenteritis
- The diagnosis of viral gastroenteritis is typically based on the presence of symptoms such as abdominal pain, diarrhea, and dehydration 2.
- The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea 2.
- Measurements of serum electrolytes, creatinine, and glucose are usually not necessary and should only be considered in a subset of children with severe dehydration who require hospitalization and IV therapy 3.
Treatment of Viral Gastroenteritis
- The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution 4, 3.
- Antiemetics, such as ondansetron, can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization 3.
- Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS) are effective in correcting dehydration and improving bowel symptoms, with Gatorade and N-ORS being rated higher in terms of taste 5.
- Adequate fluids containing physiological concentrations of glucose and electrolytes should be provided to compensate for gastrointestinal losses and cover maintenance needs 3.
- Judicious use of probiotics, antivirals, passive immunotherapy, and antidiarrheals may also be considered as potential modes of symptomatic therapy for viral gastroenteritis 6.
Prevention of Viral Gastroenteritis
- Physicians should educate caregivers on proper personal hygiene and handwashing to prevent fecal to oral transmission of the pathogen 3.
- The importance of rotavirus vaccine in the prevention of rotavirus gastroenteritis should also be emphasized 3.
- Several norovirus vaccines are currently undergoing clinical trials with promising results, which may further reduce the incidence of viral gastroenteritis 3.