What is the recommended treatment for viral gastroenteritis?

Treatment for Viral Gastroenteritis

The primary treatment for viral gastroenteritis is oral rehydration therapy (ORT) to prevent dehydration and electrolyte imbalance, as the condition is typically self-limited and resolves within a few days. 1

Rehydration Therapy

• Oral rehydration therapy (ORT) is the cornerstone of treatment, especially for children in whom the risk of fluid loss is greatest 1
• Hospitalization and intravenous fluids should be reserved only for cases with severe dehydration or when adequate oral rehydration cannot be provided 1
• For adults, maintenance of good hydration is particularly important, especially among the elderly and those receiving diuretic medications 1

Nutritional Management

• Breast milk has a protective effect against enteric infections, and most infants can be "fed through" an episode of viral gastroenteritis 1
• Early refeeding decreases intestinal permeability caused by infections, reduces illness duration, and improves nutritional outcomes 1
• Infants may experience mild lactose intolerance for 10-14 days following rotavirus infection, but most completely recover 1
• A meta-analysis found that a lactose-free diet reduced the duration of diarrhea by an average of 18 hours in children under 5 years of age 1

Symptomatic Treatment

• Bismuth subsalicylate may provide symptomatic relief, with one study showing reduction in Norwalk infection duration from 27 to 20 hours 1
• Ondansetron (an antiemetic) may be given to children over 4 years of age and adolescents with significant vomiting to facilitate oral rehydration 1
• Antimotility drugs (e.g., loperamide) should not be given to children under 18 years with acute diarrhea 1
• Loperamide may be considered for immunocompetent adults with acute watery diarrhea but should be avoided in cases of inflammatory diarrhea or diarrhea with fever 1

Special Populations

Children

• Children are at highest risk for dehydration and respond well to oral rehydration therapy 1
• Judicious use of ondansetron can increase the success of oral rehydration therapy and minimize the need for intravenous therapy and hospitalization 2

Elderly

• The elderly receiving diuretic medication require special attention to hydration status 1
• Dehydration and electrolyte imbalance pose greater risks in this population 1

Pregnant Women

• No evidence indicates that viral agents of gastroenteritis constitute a particular threat to pregnancy beyond the risks of dehydration 1
• Viremic states from these agents are not known to occur in humans, so the risk of transplacental exposure is likely low or nonexistent 1

Prevention of Transmission

• Vigorous handwashing with soap is necessary to control the spread of enteric pathogens 1
• Staff members with symptoms should be excluded from contact with susceptible persons for at least 2 days after resolution of illness 1
• Environmental surfaces should be kept clean, with special attention to areas soiled by feces or vomitus 1
• Ill persons should be separated from well persons until at least 2 days after resolution of symptoms 1

When to Seek Medical Care

• Medical attention should be sought for signs of severe dehydration, including:
  • Decreased urine output
  • Dry mouth and tongue
  • Sunken eyes
  • No tears when crying (in children)
  • Unusual drowsiness or lethargy 1

Important Considerations

• Viral gastroenteritis is typically self-limited with virus replication restricted to the gut mucosa 1
• The main risk is dehydration and electrolyte imbalance rather than the infection itself 1
• Lack of access to medical care, rather than disease virulence, is a principal risk factor for death from gastroenteritis 1
• Most cases resolve within a week without specific antiviral treatment 3