Treatment of Rotavirus Infection
The treatment of rotavirus infection is supportive care focused on preventing and correcting dehydration through oral rehydration therapy, as no antiviral medications are effective against rotavirus. 1
Primary Treatment Approach
Oral rehydration therapy (ORT) is the cornerstone of management for rotavirus gastroenteritis. 1 The main risk from rotavirus infection is dehydration and electrolyte imbalance, not the virus itself. 1
For Children (Highest Risk Group)
- Children respond well to oral rehydration therapy and should receive ORT as first-line treatment. 1
- Hospitalization with intravenous fluids is required only when dehydration is severe or when caregivers cannot provide adequate oral rehydration. 1
- Most infants can be "fed through" an episode, and breastfeeding should continue as breast milk may have protective effects. 1
- Mild lactose intolerance may occur for 10-14 days following rotavirus infection, but most infants completely recover. 1
For Adults
- Maintenance of good hydration is important, particularly among elderly patients and those receiving diuretic medications. 1
- In one study, bismuth subsalicylate reduced duration of Norwalk infection from 27 to 20 hours, though this was not specifically for rotavirus. 1
- Adult rotavirus infection typically manifests with nausea, malaise, headache, abdominal cramping, diarrhea, and fever, and is generally self-limited. 2
What NOT to Do
Antimicrobial agents and antimotility drugs should be avoided as they can worsen illness and do not treat viral gastroenteritis. 1 No antiviral therapies are currently available for rotavirus infection. 3
Special Populations Requiring Heightened Vigilance
Immunocompromised Patients
- Immunocompromised individuals (congenital immunodeficiency, transplant recipients) can experience severe, prolonged, and sometimes fatal rotavirus diarrhea. 1
- These patients may require hospitalization and more aggressive supportive care. 4
Malnourished Children
- In developing countries, acute diarrhea can convert marginal nutritional status into undernourishment, creating a cycle of diarrhea and malnutrition. 1
- More intensive monitoring and nutritional support may be needed. 1
Premature Infants
- Preterm infants lack adequate maternal antibody and are at increased risk for early and symptomatic rotavirus infection. 1
- These infants require closer monitoring for dehydration. 1
Term Neonates
- Term infants have transplacentally transferred maternal antibodies that make rotavirus infection during the first month of life tend to be mild or asymptomatic. 1
- Significant risk of illness emerges when maternal antibody levels wane between 3-6 months of life. 1
Clinical Monitoring
The typical course of rotavirus gastroenteritis includes fever, vomiting, and watery diarrhea lasting 3-8 days. 1, 5 Vomiting is particularly prominent and occurs in 80-90% of infected children. 1
- Dehydration and electrolyte disturbances are the major sequelae requiring monitoring. 1
- Most disease is self-limited in immunocompetent individuals. 1, 4
Infection Control Measures
Vigorous handwashing with soap, performed consistently at appropriate intervals, is necessary to control spread. 1 Special handwashing products are not indicated as some commercial preparations are ineffective against rotavirus. 1
- Thorough cleaning of environmental surfaces is required as a minimum to control spread. 1
- Detergents inactivate rotavirus and should be used for laundering fecally contaminated linens and clothing. 1
Common Pitfalls to Avoid
- Do not delay rehydration while pursuing diagnostic testing - the diagnosis does not change management, which remains supportive care. 3
- Do not use antibiotics - rotavirus is viral and antibiotics increase risk of complications like C. difficile infection. 1
- Do not withhold feeding - most infants can continue feeding through the illness. 1
- Lack of access to medical care, rather than disease virulence, is a principal risk factor for death from gastroenteritis in the United States. 1