Gastroenteritis supportive therapy
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Supportive Therapy for Gastroenteritis: Key Insights and Recommendations
Oral Rehydration Therapy (ORT) for Gastroenteritis
Oral rehydration therapy (ORT) is a cornerstone in the management of acute gastroenteritis, particularly in children. ORT involves the use of oral rehydration solutions (ORS) to prevent and treat dehydration caused by diarrhea. Studies have shown that ORT is effective in reducing the need for hospitalization and intravenous rehydration 12. The use of reduced osmolarity ORS, which contains lower concentrations of sodium and glucose, has been recommended globally to improve outcomes .
Nutritional Support and Continued Feeding
Maintaining an age-appropriate diet during episodes of gastroenteritis is crucial. Continued feeding, including breastfeeding, should not be interrupted as it helps in maintaining nutritional status and supports recovery 148. The traditional approach of using "clear liquids" is inadequate, and regular feeding should be resumed promptly after rehydration .
Role of Antiemetics
Antiemetics, such as ondansetron, have been found to reduce the need for intravenous rehydration and hospitalization by controlling vomiting, thereby increasing the success rate of ORT 25. However, it is important to note that ondansetron may increase the frequency of diarrhea, and its routine use requires careful consideration due to potential side effects 28.
Probiotics in Gastroenteritis Management
The use of specific probiotics, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, has been recommended as an adjunct to rehydration therapy. These probiotics have shown some efficacy in reducing the duration and severity of diarrhea in children with acute gastroenteritis 78. However, routine use of probiotics in outpatient settings is not universally endorsed due to varying levels of evidence 27.
Antibiotic Therapy
The role of antibiotics in the treatment of acute gastroenteritis is limited and generally not recommended for routine use. Studies have shown that antibiotics do not significantly impact the length of hospital stay or overall clinical outcomes in patients with gastroenteritis . Antibiotics should be reserved for specific cases where bacterial infection is confirmed or highly suspected 46.
Intravenous Rehydration
For severe dehydration, intravenous (IV) rehydration is necessary to promptly restore intravascular volume. However, oral rehydration remains the preferred method for mild to moderate dehydration due to its non-invasive nature and effectiveness 458. Rapid IV rehydration protocols do not show significant benefits over standard rehydration schemes and may lead to higher readmission rates .
Preventive Measures
Preventive strategies, including proper personal hygiene, handwashing, and vaccination, play a critical role in reducing the incidence of gastroenteritis. The rotavirus vaccine has been particularly effective in preventing rotavirus gastroenteritis, which is a common cause of severe diarrhea in children .
Conclusion
Supportive therapy for gastroenteritis primarily involves ORT, continued nutritional support, and the judicious use of antiemetics and probiotics. Antibiotics are generally not recommended unless specific bacterial infections are identified. Preventive measures, including vaccination and hygiene practices, are essential in reducing the burden of gastroenteritis. By adhering to these evidence-based guidelines, healthcare providers can effectively manage gastroenteritis and improve patient outcomes.
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