Rotavirus is the leading cause of gastroenteritis in children, and is considered the most common cause of severe diarrhea in children under the age of 5 worldwide. Infection with this virus represents a major burden for the health care system and society, but it also has a substantial psychosocial impact on the families of affected children.
Improved personal hygiene and community sanitation measures resulted in the reduction of prevalence of bacterial and parasitic disease. On the other hand, these measures have shown negligible effects on the spread of rotavirus and its potential complications – including severe dehydration, hospitalization, and (in certain instances) death.
Although gastroenteritis caused by rotavirus is regarded as a self-limiting disease, dangerous combination of vomiting, watery diarrhea and fever often leads to rapid dehydration. Therefore prevention of dehydration represents a key step in treating rotaviral gastroenteritis in children.
Oral rehydration therapy
A continuation of usual diet and adequate fluid intake is recommended for children with minimal or no dehydration at all. Different studies have established that a child’s regular diet reduces the duration of diarrhea. Breastfeeding should continue in infants who are breast fed, and in those who are formula-fed, diluting the formula is not recommended.
Prompt oral rehydration therapy using an oral rehydration solution before the child becomes more severely dehydrated is pivotal. Oral rehydration therapy which contains water and small amounts of salt and sugar (as recommended by the World Health Organization) is given as the first line of treatment with more than 90% of effectiveness.
Liquids such as plain water, sodas, apple juice or chicken broth do not represent viable alternatives to oral rehydration therapy due to their hyperosmolarity and inability to adequately replace sodium, potassium and bicarbonate. In addition, these fluids (particularly water and apple juice) can result in hyponatremia.
Ondansetron (5-hydroxytryptamine-3 serotonin antagonist) can be given as an emergency if vomiting is hampering oral rehydration therapy. Infants who appear significantly dehydrated should ideally have 20 ml/kg isotonic sodium chloride or Ringer lactate solution administered on the way to the hospital.
The administration of intravenous fluids requires at least six hours in the emergency department or an overnight stay in the hospital. Depending on the severity of dehydration, two intravenous lines or an intraosseous line can be introduced. Rehydration with intravenous fluids will correct the sodium and water deficit, but also the ongoing fluid deficit.
Probiotics and other drugs
Probiotics have shown certain benefits in modulating the immune response against foreign antigens in children with rotaviral gastroenteritis, but also other types of diarrheal illnesses. Well-controlled clinical trials have shown that probiotics such as Lactobacillus rhamnosus GG, Lactobacillus casei, Lactobacillus reuteri and Saccharomyces boulardii can be used for that purpose.
Nitazoxanide – a nitrothiazole benzamide compound notable for its activity in treating intestinal protozoal and helminthic infections – has also shown promise in treating severe cases of rotaviral gastroenteritis. Although immunoglobulin preparations have been assessed in pediatric patients, there are still no clear guidelines for their use in diarrhea caused by rotaviruses.
Antidiarrheal medications should not be given to children with acute rotaviral gastroenteritis since they can delay the elimination of virus from the intestines. Racecadotril (acetorphan), an antisecretory drug that inhibits intestinal enkephalinase without slowing intestinal transit, has shown effective in reducing stool output and duration of diarrhea in rotavirus infections.