From the Guidelines
Treatment for gastroenteritis should primarily focus on preventing dehydration and managing symptoms, with oral rehydration therapy as the cornerstone of treatment. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, ancillary treatment with antimotility, antinausea, or antiemetic agents can be considered once the patient is adequately hydrated.
Key considerations in managing gastroenteritis include:
- Oral rehydration therapy to prevent dehydration
- Antimotility drugs like loperamide may be given to immunocompetent adults with acute watery diarrhea, but should be avoided in children under 18 years of age and in cases where toxic megacolon may result 1
- Antinausea and antiemetic agents like ondansetron may be given to children over 4 years of age and adolescents to facilitate tolerance of oral rehydration 1
- A bland diet, including foods like bananas, rice, applesauce, and toast, is recommended as tolerated
It is essential to note that most cases of gastroenteritis are viral and self-limiting, typically resolving within 3-5 days without antibiotics. Loperamide should not be given to children under 18 years of age with acute diarrhea, and its use should be avoided in suspected or proven cases where toxic megacolon may result 1. Maintaining good hygiene, including thorough handwashing, is crucial to prevent spreading the infection to others. Medical attention should be sought if symptoms include severe dehydration, bloody stools, persistent vomiting, high fever above 102°F (39°C), or symptoms lasting more than 3-5 days.
From the Research
Treatment Options for Gastroenteritis
- Oral rehydration therapy is an effective and inexpensive treatment for dehydration due to gastroenteritis in children, as shown in a study published in 2006 2.
- A study from 2019 found that oral rehydration therapy can be managed at home for mild gastroenteritis in children, and is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 3.
- For severe dehydration, hospitalization and intravenous fluids are recommended, along with the use of ondansetron to prevent vomiting and improve tolerance of oral rehydration solutions 3, 4.
Oral Rehydration Solutions
- A randomized, controlled trial of 3 solutions (Pedialyte, Gatorade, and a New Oral Rehydration Solution) found that all three solutions were effective in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 5.
- The World Health Organization recommended a formulation of oral rehydration salts, but modifications such as low osmolarity, rice-based, and the addition of probiotics, prebiotics, and/or zinc have been proposed to increase tolerability and shorten the duration of diarrhea 6.
Management of Gastroenteritis
- Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output, and physical examination is the best way to evaluate hydration status 3.
- The four-item Clinical Dehydration Scale can be used to determine severity of dehydration based on physical examination findings 3.
- Handwashing, breastfeeding, and rotavirus vaccination can reduce the incidence of acute gastroenteritis in young children 3.