From the Guidelines
Gastroenteritis treatment should prioritize oral rehydration therapy and symptom management, with antibiotics reserved for severe or specific cases, as most cases are caused by viruses and resolve within 3-5 days. The primary treatment for mild to moderate gastroenteritis involves 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.
For symptom management, anti-diarrheal medications like loperamide (Imodium) can be used in adults, but should be avoided in children and cases with high fever or bloody diarrhea due to the risk of adverse events, including ileus, abdominal distension, and lethargy 1. Antiemetics such as ondansetron (Zofran) may help control vomiting, especially in children, as it has been shown to reduce vomiting and the need for hospitalization for rehydration 1.
In terms of diet, following the BRAT diet (bananas, rice, applesauce, toast) initially and then gradually returning to normal eating can help manage symptoms. Most cases of gastroenteritis resolve without antibiotics, but in severe or specific cases, such as dysentery or infections with certain bacteria, antibiotics like azithromycin may be necessary 1. Azithromycin is recommended as the first-line agent for dysentery and acute watery diarrhea with greater than mild fever due to its efficacy and safety profile 1.
It is essential to seek medical attention if symptoms persist beyond 5 days, if there's severe dehydration, bloody stools, or high fever (above 102°F/39°C). Handwashing and food safety practices are crucial in preventing the transmission of gastroenteritis, which is highly contagious through the fecal-oral route. Key considerations in managing gastroenteritis include:
- Oral rehydration therapy as the primary treatment
- Symptom management with anti-diarrheal and antiemetic medications in specific cases
- Antibiotics reserved for severe or specific cases
- Dietary management with the BRAT diet
- Prevention through handwashing and food safety practices.
From the Research
Definition and Symptoms of Gastroenteritis
- Gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain 2
- The main symptoms of gastroenteritis include diarrhea, vomiting, and dehydration
Assessment and Diagnosis of Dehydration
- The three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern 2
- Laboratory data points may be obtained in select patients, but no single laboratory value has been found to be accurate in predicting the degree of dehydration 2
- Clinical dehydration scales can be used to assess the level of dehydration 3
Treatment and Management of Gastroenteritis
- Oral rehydration therapy with a rehydration solution is the best means of rehydrating children with mild to moderate dehydration 4, 2, 3
- Ondansetron can be used as an adjunct to oral rehydration therapy to help children with persistent vomiting 4, 2, 3
- Antiemetics can decrease the need for intravenous fluids and hospitalization 4
- Rapid intravenous rehydration (RIR) can be used in children with mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity 5
- Isotonic fluids are recommended for RIR, with a rhythm of 20 cc/kg/h for 1-4 hours 5