Gastroenteritis%20-%20viral Treatment

Treatment

Principles of Therapy

Viral gastroenteritis is generally a self-limiting illness
Treatment is based on the degree of dehydration
Oral replacement therapy (ORT) encompasses 2 phases of treatment:
- Rehydration phase: Electrolytes and water are administered as oral rehydration solution (ORS) to replenish fluid losses
  - Should be performed rapidly within 3-4 hours
- Maintenance phase: Restoration of ongoing fluid and electrolyte losses, and adequate dietary intake
Age-appropriate diet (including solids) for rapid realimentation is recommended once adequate degree of hydration is attained
Breastfeeding should be continued especially for breastfed patients
Changes in formula milk are not necessary

Pharmacotherapy

No specific antiviral therapy is available
Based on several controlled studies, antidiarrheal medications have shown no benefit in patients with viral gastroenteritis
Antiemetic agents (eg Ondansetron) may be used in children ≥6 months of age with mild to moderate dehydration, and intense and/or persistent vomiting that interferes with oral rehydration therapy (ORT), to decrease vomiting or help avoid the need for intravenous fluid, but may increase episodes of diarrhea
Zinc supplementation given during an episode of diarrhea may decrease the duration and severity of diarrheal illness and reduce the incidence of diarrhea in the next 2-3 months
- For patients up to 6 months old, may give 10 mg/day PO x 10-14 days
- Patients ≥6 months old, may give 20 mg/day PO x 10-14 days
Probiotics have been shown to reduce the intensity and duration of acute infectious diarrhea in children
- May be used in rotavirus gastroenteritis
- Examples include Lactobacillus spp, Saccharomyces boulardii, Bifidobacterium spp
Racecadotril, an antisecretory agent, may be used as an adjunctive therapy in acute diarrhea
- Studies showed decreased diarrhea duration and reduced stool output following administration of Racecadotril in children with acute diarrhea
Smectite (Diosmectite), an adsorbent, may have a role in the treatment of acute viral gastroenteritis in children but further studies are recommended
Bovine colostrum contains antimicrobial peptides (lactoferrin, lactoperoxidase), immune-regulating and inflammatory cytokines, and growth factors that may help provide passive immunity by enhancing different immune functions (eg phagocytosis, antigen presentation, antimicrobial activity via antigen chelation, inflammation control) in the gastrointestinal tract
- Studies showed that bovine colostrum improved clinical symptoms (eg reduced stool frequency, reduced occurrence and duration of diarrhea) in children with infectious diarrhea
- Clinical benefit in the prevention and management of infectious diarrhea is currently undergoing clinical trials
Human milk, gelatin tannate and other probiotics are being studied to conclude their use in the management of gastroenteritis

Non-Pharmacological Therapy

Dietary Therapy

Depends on age and diet history
Breastfed patients should continue nursing on demand while formula-fed patients must continue their usual full-strength milk
- Based on several trials, feedings with diluted formula are associated with protracted symptoms and delayed nutritional recovery
Lactose-free formulas are recommended in patients with documented and persistent lactose intolerance
Intake of patient’s usual diet is recommended
Recommended foods include complex carbohydrates, lean meats, yogurt, fruits and vegetables
- Highly specific diets [eg BRAT (banana, rice, applesauce and toast) diet] have been commonly recommended, however these may provide insufficient nutrition for patient’s nourishment and recovering gut
Foods high in simple sugars should be avoided

Indications for Hospital Admission

Severely dehydrated
Difficulties in ORT administration (eg continuous vomiting, refusal or inadequate intake of ORS)
Failure of ORS treatment including worsening diarrhea or dehydration despite adequate volumes
Presence of coexisting illnesses
Family incapable of providing adequate care at home
Concerns that might prevent return for evaluation or follow-up
Presence of the following factors: Young age, changes in sensorium, advancing course of symptoms, need for close monitoring due to ambiguous diagnosis

Countering the menace of the common cold with zinc

13 Jun 2017

The common cold is one of the most widespread illness and is a leading cause of visits to the doctor and absenteeism from school and work. While many may see it as merely a harmless inconvenience, the significant repercussions it brings, especially among children cannot be denied. MIMS JPOG recently spoke to Associate Professor Datin Dr Asmiati Abd Hamid to gain her perspectives on the role of zinc and vitamin C in treating paediatric common cold to reduce morbidity and economic losses attributed to the condition.

Acute diarrhoea is the second leading cause of death in children aged younger than 5 years, accounting for approximately 1.9 million deaths worldwide each year; however, diarrhoea is a preventable and treatable condition. In Malaysia, acute gastroenteritis accounts for about 1.3% of all deaths in children aged younger than 5 years annually. Diarrhoea is defined as the passage of three or more loose or watery stools within 24 hours, and it may be clinically categorised as either acute watery diarrhoea (AWD), acute bloody diarrhoea, persistent diarrhoea or diarrhoea with severe malnutrition.

01 Sep 2020

Acute diarrhoea is the second leading cause of deathin children aged younger than 5 years, accounting forapproximately 1.9 million deaths worldwide each year;however, diarrhoea is a preventable and treatable condition.In Malaysia, acute gastroenteritis accounts for about 1.3%of all deaths in children aged younger than 5 years annually.Diarrhoea is defined as the passage of three or more looseor watery stools within 24 hours, and it may be clinicallycategorised as either acute watery diarrhoea (AWD), acutebloody diarrhoea, persistent diarrhoea or diarrhoea withsevere malnutrition.

A conversation on influenza

01 Mar 2017

At the recent Asia Pacific Alliance for the Control of Influenza (APACI) workshop in Kuala Lumpur, MIMS Doctor had the privilege of having an exclusive interview with eminent paediatric infectious disease specialist, Associate Professor Tawee Chotpitayasunondh. This article captures the highlights from our conversation with him.