Treatment for Norovirus
The primary treatment for an otherwise healthy individual with norovirus is oral rehydration therapy to prevent dehydration, as the infection is self-limited and requires no specific antiviral therapy. 1, 2
Core Treatment Strategy
Oral rehydration is the cornerstone of management, with the goal of preventing dehydration through aggressive fluid replacement. 1, 2 The illness typically resolves spontaneously within 12-72 hours in immunocompetent individuals. 1, 3
When to Escalate to IV Fluids
Escalate to intravenous fluid therapy if: 1
- Oral intake is inadequate
- Signs of severe dehydration are present
- The patient cannot tolerate oral rehydration
Approximately 10% of norovirus patients require medical attention, including hospitalization for dehydration management. 1
Symptomatic Management
Antimotility agents (such as loperamide) may be used in immunocompetent adults with nonbloody diarrhea as part of self-treatment. 1, 2 This can provide symptomatic relief while the infection runs its course.
Expected Clinical Timeline
Symptoms begin 12-48 hours after exposure and typically last 12-72 hours with self-resolution in healthy individuals. 1, 2 However, be aware that: 2
- Young children, elderly patients, and hospitalized individuals may experience longer courses of 4-6 days
- Vomiting or diarrhea persisting beyond one week is atypical and requires immediate evaluation for alternative diagnoses 1, 2
Critical Infection Control
Handwashing with soap and running water for at least 20 seconds is the most effective method to reduce norovirus contamination, as alcohol-based hand sanitizers have limited efficacy against this virus. 1, 2, 3 Alcohol-based sanitizers (≥70% ethanol) may be used as an adjunct between proper handwashings but should never substitute for soap and water. 3
Isolation Requirements
- Isolate ill patients in institutional settings until 24-48 hours after complete symptom resolution 1, 2, 3
- Exclude ill healthcare workers and food handlers from work until 48-72 hours after symptom resolution 1, 2, 3
When to Seek Medical Attention
Hospitalization is required for: 1
- Severe dehydration unresponsive to oral rehydration therapy
- Elderly patients or those in long-term care facilities with significant symptoms
- Immunocompromised patients with prolonged symptoms or evidence of malnutrition
Special Populations at Risk
Immunocompromised patients face significantly different outcomes, with mortality rates up to 25% in allogeneic stem cell transplant recipients. 1 These patients can develop prolonged infection lasting months to years with severe malnutrition and continuous viral shedding. 3, 4