Viral Gastroenteritis Treatment & Management

Updated: Jan 08, 2018
  • Author: Brian Lin; Chief Editor: Burt Cagir, MD, FACS  more...
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Treatment

Medical Care

In 1996, the American Academy of Pediatrics (AAP) formulated and published practice guidelines for the management of acute gastroenteritis in children. [30] The AAP continues to update these guidelines [31] and/or endorses those from other health organizations, including the Centers for Disease Control and Prevention. [32] Use the following parameters to assess the degree of dehydration: blood pressure, pulse, heart rate, skin turgor, fontanelle, mucous membranes, eyes, extremities, mental status, urine output, and thirst.

  • The treatment of rotavirus diarrhea is based primarily on replacing fluids and electrolytes, as directed by the estimated degree of dehydration.

  • Oral rehydration therapy is recommended for preventing and treating early dehydration and continued replacement therapy for ongoing loses.

  • Shock, severe dehydration, and decreased consciousness require intravenous therapy.

  • Age-appropriate diets should be continued in children with diarrhea who are not dehydrated. When mild-to-moderately dehydrated children are rehydrated, resume age-appropriate diet.

  • Administering antiemetics and antidiarrheal agents to small children is not recommended.

  • Several studies have shown that antirotavirus immunoglobulin, as pooled gamma globulin, bovine colostrum, or human milk, may decrease frequency and duration of diarrhea.

  • Small studies have suggested that zinc supplements may reduce the severity and duration of illness.

Probiotics are nonpathogenic live microorganisms that provide beneficial effects on the health of the host. In recent years, probiotics have entered mainstream medical practice, as a decrease in the severity and duration of infectious gastroenteritis has been shown in some strains. [33]

  • Probiotics help to improve the balance of the intestinal microflora, although the exact mechanism of action is incompletely understood. Hypothesized mechanisms include suppression of growth or invasion by pathogenic bacteria, improvement of intestinal barrier function, and effects on immune function. [34]

  • Literature shows a statistically significant, but clinically moderate, benefit for some strains, mainly in infants and young children, in the treatment of acute watery diarrhea, especially in rotavirus gastroenteritis. [33]

  • Until further data are available, only those organisms that have been clinically tested can be reasonably recommended, Lactobacillus casei GG and Saccharomyces boulardii being the most reported. Limited data and modest expected benefit must be explained to patients. [33]

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Prevention

Natural infection with rotavirus does not afford complete immunity, and multiple infections in the first few years of life probably are common; however, immune response to these infections reduces the frequency and severity of subsequent rotavirus infection.

The Centers for Disease Control and Prevention (CDC) recommend administering rotavirus vaccine in infants. There are two licensed rotavirus vaccines for use in infants in the United States: RotaTeq (RV5), an oral attenuated pentavalent rotavirus vaccine (PRV), is given in three doses at age 2, 4, and 6 months, and Rotarix (RV1), an oral attenuated monovalent rotavirus vaccine, is given in two doses, at age 2 and 4 months. [35]

The Rotarix vaccine strain replicates well in the gut after the first dose and provides cross-protection against most other serotypes. RotaTeq, however, is not so broadly cross-protective and grows less well in human intestines. In addition, the vaccine strains are infrequently shed in the stool, and 3 doses are required. [36]

RotaShield was removed from the market in the United States in 1999 owing to an association between this vaccine and intussception. [37]

Proper hygiene is still the first essential preventative step in viral gastroenteritis, [1] particularly in households with two or more primary cases of norovirus and at least one primary case with diarrhea. [38] Hand washing to prevent fecal-oral transmission is very important. It also includes properly handling food and using clean water supplies.

On a community level, proper sanitation, clean water supplies, and surveillance programs for outbreaks are important steps in prevention.

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