From the Guidelines
Gastroenteritis management should prioritize oral rehydration therapy and supportive care, as most cases are self-limiting and resolve within 1-3 days. The primary treatment for mild to moderate cases is oral rehydration therapy using solutions like Pedialyte, Gatorade, or homemade mixtures (1 teaspoon salt, 8 teaspoons sugar in 1 liter of clean water) 1. Adults should drink at least 2-3 liters daily, while children need smaller amounts based on weight.
Key Considerations
- Anti-diarrheal medications like loperamide (Imodium) 4mg initially followed by 2mg after each loose stool (maximum 16mg daily) can help reduce symptoms in adults, but should be avoided in children and cases with high fever or bloody diarrhea 1.
- Antiemetics such as ondansetron (4-8mg every 8 hours) may be prescribed for severe vomiting.
- A bland diet including bananas, rice, applesauce, and toast (BRAT diet) can be followed initially, gradually returning to normal eating as symptoms improve.
- Bacterial cases may require antibiotics like ciprofloxacin (500mg twice daily for 3-5 days) if severe or persistent.
- Handwashing and food safety practices are essential for prevention, as the condition is highly contagious through contaminated food, water, or direct contact with infected individuals.
Probiotics and Gastroenteritis
The use of probiotics in gastroenteritis is not recommended, especially in children, as suggested by the AGA guidelines 1. The evidence for probiotics in acute infectious gastroenteritis is moderate, but it does not support their use in children in the United States and Canada.
Prevention
Prevention measures include:
- Hand hygiene
- Proper food preparation and storage
- Avoidance of high-risk foods such as undercooked meat and seafood, unpasteurized milk, and soft cheese made with unpasteurized milk
- Avoidance of unsafe water
- Use of infection prevention and control measures in hospitals, childcare, and nursing home settings
- Appropriate use of antimicrobial agents
- Appropriate pet selection and supervision of contact with animals, specifically in public settings
- Refraining from recreational water activities, food preparation or service, and sexual activities while symptomatic 1.
From the FDA Drug Label
The adverse effects reported during clinical investigations of loperamide hydrochloride are difficult to distinguish from symptoms associated with the diarrheal syndrome. Adverse experiences recorded during clinical studies with loperamide hydrochloride were generally of a minor and self-limiting nature They were more commonly observed during the treatment of chronic diarrhea. The adverse events with an incidence of 1. 0% or greater, which were reported at least as often in patients on loperamide hydrochloride as on placebo, are presented in the table below. Gastrointestinal AE% Constipation 2.6% 0.8% The adverse events with an incidence of 1. 0% or greater, which were more frequently reported in patients on placebo than on loperamide hydrochloride, were: dry mouth, flatulence, abdominal cramp and colic.
Gastroenteritis is not directly addressed in the provided drug label for loperamide (PO) 2. The label discusses adverse events related to the treatment of acute diarrhea and chronic diarrhea, but does not provide information on gastroenteritis specifically.
From the Research
Definition and Prevalence of Gastroenteritis
- Gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain 3.
- In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year 3.
Evaluation and 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.
- 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 3, 4.
- Antiemetics, such as ondansetron, may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 3, 5.
Treatment Options for Gastroenteritis
- Oral rehydration solutions are recommended for moderate dehydration 3.
- Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration 3.
- Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children 3.
- Modifications to the original oral rehydration salts formula, such as low osmolarity, rice-based, and addition of probiotics, prebiotics, and/or zinc, have been proposed to increase tolerability and shorten the duration of diarrhea 6.
Evidence-Based Recommendations
- The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy 5.
- Ondansetron may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration 5.
- Gatorade and a New Oral Rehydration Solution (N-ORS) seem to be as effective as Pedialyte in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 7.