Treatment Approach for Acute Gastroenteritis

Assessment and Rehydration

The treatment approach for food poisoning and acute gastroenteritis is identical, requiring evidence-based management focused on rehydration, supportive care, and selective antimicrobial therapy based on specific clinical criteria, as recommended by the Infectious Diseases Society of America 1
Evaluate for clinical signs of dehydration, including mild dehydration (3-5%), moderate dehydration (6-9%), and severe dehydration (≥10%), to guide rehydration therapy 2
For mild to moderate dehydration, reduced osmolarity oral rehydration solution (ORS) is first-line therapy, with administration of 100 mL/kg over 2-4 hours for moderate dehydration 1, 2
Isotonic intravenous fluids (lactated Ringer's or normal saline) are mandatory for severe dehydration, shock, or altered mental status, with continuation of IV therapy until pulse, perfusion, and mental status normalize 1, 2

Do not give empiric antibiotics for typical watery diarrhea, as 70% of cases are viral and antibiotics provide no benefit, according to the Infectious Diseases Society of America 1, 2
Empiric antimicrobials should only be given for specific scenarios, including bloody diarrhea with suspected bacterial etiology, fever, abdominal pain, and bacillary dysentery, as recommended by the Infectious Diseases Society of America 1
Empiric antibiotic choices include ciprofloxacin or azithromycin for adults, and azithromycin for children, based on local susceptibility and travel history 1

Ondansetron may be given to children >4 years and adults with significant vomiting to facilitate oral rehydration, as recommended by the American Academy of Pediatrics 2
Loperamide 2 mg may be given to immunocompetent adults with watery diarrhea once adequately hydrated, but should never be given to children <18 years or anyone with bloody diarrhea or high fever, according to the Infectious Diseases Society of America 1, 2

Resume age-appropriate diet immediately during or after rehydration, without restricting diet, as recommended by the American Academy of Pediatrics 2, 3
Continue breastfeeding throughout illness in infants, and avoid foods high in simple sugars, fatty/spicy foods, and caffeine 2, 3

Hospitalize patients with severe dehydration (≥10% fluid deficit), signs of shock or persistent hypotension, altered mental status, intractable vomiting, or failure of oral rehydration therapy, as recommended by the American College of Emergency Physicians 2
Consider hospitalization for age <3 months, age ≥65 years with moderate dehydration, immunocompromised status, or bloody diarrhea with fever and systemic toxicity, according to the Infectious Diseases Society of America 1, 2

Essential infection control measures include hand hygiene, use of gloves and gowns, cleaning and disinfecting contaminated surfaces, and separating ill persons from well persons, as recommended by the Centers for Disease Control and Prevention 2, 3