From the Guidelines
For patients with gastroenteritis, oral rehydration therapy using reduced osmolarity oral rehydration solutions (ORS) is the recommended first-line therapy for mild to moderate dehydration in infants, children, and adults, as it has been shown to be effective in reducing morbidity and mortality 1.
Key Recommendations
- Oral rehydration therapy should be initiated as soon as possible, with the goal of correcting dehydration within 3-4 hours.
- The recommended ORS solution is a reduced osmolarity solution, which can be given to all age groups, with any cause of diarrhea.
- For infants and children, the recommended dose is 50-100 mL/kg over 3-4 hours, while for adolescents and adults, the recommended dose is 2-4 L.
- Nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration who cannot tolerate oral intake.
Management of Dehydration
- For mild to moderate dehydration, ORS is the preferred treatment, while for severe dehydration, intravenous isotonic crystalloid boluses should be administered until pulse, perfusion, and mental status return to normal.
- Once the patient is rehydrated, maintenance fluids should be administered, and ongoing losses in stools should be replaced with ORS until diarrhea and vomiting are resolved.
Antibiotic Therapy
- Antibiotics may be considered in cases of severe travelers' diarrhea, dysentery, or moderate to severe acute bacterial diarrhea, with azithromycin being the recommended first-line agent due to its efficacy and safety profile 1.
- The choice of antibiotic should be based on the severity of illness, regional patterns of probable target pathogens, and their antimicrobial resistance.
Prevention
- Handwashing and food safety practices are essential for prevention, as gastroenteritis spreads easily through contaminated food, water, or person-to-person contact.
- Breastfed infants should continue nursing throughout the illness, and children previously receiving a lactose-containing formula can tolerate the same product in most instances.
From the Research
Definition and Epidemiology
- Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain 2.
- In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year 2.
- Approximately 178 million cases of acute gastroenteritis occur annually in the United States, resulting in 473,000 hospitalizations and 5000 deaths 3.
Diagnosis and Evaluation
- Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output 2.
- The physical examination is the best way to evaluate hydration status, and the four-item Clinical Dehydration Scale can be used to determine severity of dehydration based on physical examination findings 2.
- In children with mild illness, stool microbiological tests are not routinely needed when viral gastroenteritis is the likely diagnosis 2.
Treatment and Management
- Oral rehydration therapy is the mainstay of treatment for mild dehydration and is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 2, 4.
- Oral rehydration solutions are recommended for moderate dehydration, and ondansetron may be prescribed if needed to prevent vomiting and improve tolerance of oral rehydration solutions 2.
- Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration 2.
- Antibiotics may be indicated in certain cases of acute gastroenteritis, and guidelines have been developed to promote appropriate antibiotic use and prevent antibiotic resistance 5.
Prevention
- Handwashing, breastfeeding, and rotavirus vaccination can reduce the incidence of acute gastroenteritis in young children 2.