Treatment and Supportive Management for Acute Gastroenteritis (GI Bug)
For acute viral or bacterial gastroenteritis, prioritize supportive care with oral rehydration, monitor for dehydration, and avoid antimotility agents like loperamide until infection is ruled out. 1
Immediate Assessment and Monitoring
Rule out infectious causes before initiating symptomatic treatment. Testing for bacterial pathogens (Salmonella, Campylobacter, Shigella) and parasites should be considered if symptoms are severe, bloody, or persistent beyond 3-5 days. 2 Stool inflammatory markers can help differentiate infectious colitis from other causes. 1
Key Clinical Features to Assess:
- Dehydration status: Check for decreased urine output, dry mucous membranes, tachycardia, and orthostatic hypotension 1
- Fever and systemic symptoms: Temperature >38.5°C suggests bacterial infection requiring different management 1
- Blood or mucus in stool: Indicates inflammatory or invasive infection 1
- Abdominal pain severity: Severe, persistent pain may indicate complications requiring imaging 1
Supportive Care Measures
Hydration Management
Oral rehydration is the cornerstone of treatment. Patients should increase fluid intake with electrolyte-containing solutions. 1 Monitor closely for signs of dehydration every 3 days or more frequently if symptoms worsen. 1
Dietary Modifications
Recommend temporary dietary changes during acute illness. Avoid large meals, late-night eating, and foods that exacerbate symptoms. 1 Small, frequent meals are better tolerated. 1 Once symptoms improve, gradually reintroduce normal diet.
Symptomatic Treatment
Loperamide may be used ONLY after infection has been ruled out and only for diarrhea without colitis symptoms. 1 This is a temporary measure and should not be used if there is:
When to Escalate Care
Grade 2 Severity (4-6 stools/day above baseline)
If symptoms persist beyond 48-72 hours or worsen:
- Consider gastroenterology consultation 1
- Obtain stool studies including culture and inflammatory markers 1
- Consider imaging if abdominal pain is severe or persistent 1
Grade 3-4 Severity (≥7 stools/day, incontinence, severe symptoms)
Hospitalization should be considered for adequate supportive care. 1 Intravenous fluid resuscitation may be necessary. 1
Specific Pathogen Considerations
Parasitic Infections
If travel history or prolonged symptoms (>7-10 days) suggest parasitic infection:
- Giardia: Requires specific antiparasitic treatment 3
- Strongyloides: Treat with ivermectin 200 μg/kg single dose 3
- Pinworm (Enterobius): Diagnose with cellophane tape test, treat with albendazole 400 mg single dose 1, 4
Bacterial Infections
Most bacterial gastroenteritis is self-limited and does not require antibiotics. 2 However, specific pathogens may require targeted therapy based on culture results and clinical severity. 1
Common Pitfalls to Avoid
Never use antimotility agents before ruling out infection. 1 This can worsen outcomes in infectious colitis and may precipitate toxic megacolon in severe cases.
Do not ignore persistent symptoms beyond 5-7 days. 1 This warrants diagnostic investigation including imaging and possible endoscopy. 1
Avoid NSAIDs for symptom management as they can worsen gastrointestinal symptoms. 5 Acetaminophen is safer for fever or discomfort. 5
Duration of Symptoms and Follow-up
Most viral gastroenteritis resolves within 3-5 days with supportive care alone. 2 If symptoms persist beyond this timeframe or worsen, reassess for:
Monitor patients closely by phone or electronic system every 3 days until symptoms stabilize. 1 Patients should contact their provider immediately if they develop fever, severe abdominal pain, bloody stools, or signs of dehydration. 1