Diagnosis and Management of Acute Gastroenteritis in the Emergency Department (Pharmacology CME)

Points & Pearls Excerpt

• Acute gastroenteritis (AGE) is inflammation of the GI tract, typically due to an infection. Predominant symptoms may include vomiting and/or diarrhea (though not always), along with fever and abdominal pain, in some cases.
• Each year, AGE results in almost 500,000 hospitalizations and 5000 deaths.
• A causative organism is never identified in approximately 80% of cases, and even when stool sample is sent, the organism is identified only 25% of the time.
• Risk factors include travel to areas with poor sanitation practices, exposure to zoonoses, time spent in healthcare facilities, immunosuppression, and insufficient vaccination status.

Most Important References

• Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):1963-1973. (Guidelines) 
• Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602-622. (Guidelines) 
• Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71-80. (Review; 122 articles) 
• Wistrom J, Jertborn M, Ekwall E, et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med. 1992;117(3):202-208. (Prospective; 511 patients) 
• Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis. 2011;17(1):7-15. (Data analysis) 
• Freedman SB, Willan AR, Boutis K, et al. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA. 2016;315(18):1966-1974. (Prospective; 647 patients)
• Roslund G, Hepps TS, McQuillen KK. The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Ann Emerg Med. 2008;52(1):22-29. (Prospective; 106 patients)
• Furyk JS, Meek RA, Egerton-Warburton D. Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. Cochrane Database Syst Rev. 2015(9):CD010106. (Cochrane review; 8 trials, 952 participants)
• De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers’ diarrhoea. Cochrane Database Syst Rev. 2000(3):CD002242. (Cochrane review; 20 studies)
• Adachi JA, Ericsson CD, Jiang ZD, et al. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico. Clin Infect Dis. 2003;37(9):1165-1171. (Prospective; 217 patients)