Treatment

Infectious gastroenteritis is usually self-limiting. Supportive therapy may suffice for most patients.

• Diet and fluids

  • Bland diet: e.g., broths, saltine crackers, boiled vegetables

  • Oral rehydration therapy or intravenous fluid therapy: i.e., fluid replacement or fluid resuscitation

  • Oral or parenteral electrolyte repletion

• Pharmacotherapy (not routinely recommended)

  • Oral or parenteral antiemetics as needed: e.g., ondansetron or promethazine)

  • Consider antimotility drugs (e.g., loperamide) for immunocompetent adult patients with acute watery diarrhea.

Antimotility drugs (e.g., loperamide) should be avoided in patients with fever or inflammatory diarrhea because of the risk of developing toxic megacolon.

Antibiotic therapy is not routinely indicated in bacterial gastroenteritis. When indications for empiric antibiotics exist, they should be started after appropriate cultures have been collected.

• Empiric antibiotics for bacterial gastroenteritis

  • Indications include:

    • Suspected Shigella infection

    • Suspected enteric fever

    • High-grade fever or sepsis

    • High-risk groups

  • Recommended regimens (adult patients)

    • Azithromycin

    • Ciprofloxacin

  • Trimethoprim/sulfamethoxazole is not recommended because of high resistance rates.

• Targeted therapy: Once a pathogen has been identified, modify therapy accordingly.

  • E.g., treatment for C. difficile infection

  • Consider discontinuing or adjusting therapy for other pathogens (see relevant sections below for details).

Antibiotic therapy is contraindicated for enterohemorrhagic E. coli. It may increase the risk of or worsen HUS.

• Dehydration (most common; especially severe in shigellosis and cholera)

• Malnutrition

• Permanent carrier status (chronic Salmonella carrier)

• Reactive arthritis

• Postinfectious irritable bowel syndrome

• Food and water hygiene

• Educate patients and caregivers on preventing onward community transmission of infectious gastroenteritis.

  • Regular hand hygiene with soap and water including after changing diapers.

  • Clean bathrooms, high-touch, and contaminated areas with bleach-based cleaners.

• Nationally notifiable diseases in the US include:

  • Salmonellosis

  • Shigellosis

  • STEC colitis

  • Vibrio (cholera and noncholera species) infections

• Other suspected outbreaks should be reported to local health departments.

• Infants: rotavirus vaccination

• Specific vaccines (e.g., typhoid vaccine, cholera vaccine) may be recommended for international travelers depending on the destination.