What are the treatment options for bacterial gastroenteritis?

Updated: Jul 17, 2018
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: BS Anand, MD  more...
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Answer

Because most infectious diarrhea is self-limited, medical care is primarily supportive in nature. Oral rehydration therapy is the cornerstone of diarrhea treatment, especially for small bowel infections that produce a large volume of watery stool output. Studies confirm that early refeeding hastens recovery. Many commercial oral rehydration formulas are available and have been designed to promote optimal absorption of nutrients.

Young infants and neonates are at a high risk for secondary complications and require close monitoring, as do older individuals.

Consider intravenous rehydration when oral rehydration is unsuccessful. Particular attention must be paid to repletion of potassium as needed.

Administer maintenance fluids plus replacement of losses to ill children. Administer small amounts of fluid at frequent intervals in order to minimize discomfort and vomiting. A 5 or 10cc syringe without a needle is a very useful tool. The syringe can be used to place small amounts of fluid in the mouth quickly. Once the patient becomes better hydrated, cooperation improves enough for the patient to take small sips from a cup. This method is time intensive and requires dedication. Encouragement from the physician is necessary to promote compliance.

Live Lactobacillus GG and heat-killed Lactobacillus LB reduce the duration of diarrhea in children when they are added to oral rehydration solution. [1, 2]  A systematic review and meta-analysis of 31 randomized-controlled trials comprising 8672 children and adults suggests with moderate certainty that probiotics are effective for preventing C difficile-associated diarrhea and that short-term use of probiotics in conjunction with antibiotics appears to be safe in those who are immunocompetent and those who aren't severely debilitated. [45] Adverse effects appeared in 32 trials assessed, but they were more common in the control groups.

Antimicrobial therapy is indicated for some bacterial gastroenteritis infections. However, many conditions are self-limited and do not require therapy.

Antimotility agents are not indicated routinely for infectious diarrhea (except for refractory cases of Cryptosporidium infection).


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