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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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If outpatient management fails, intervention with IV fluids generally is necessary to correct dehydration, provide appropriate replacement fluids for ongoing losses due to vomiting and diarrhea, and guarantee administration of daily maintenance fluids. Various formulas to calculate the necessary volume and composition of these fluids as well as their rate of administration are available. Correction of moderate to severe dehydration may require up to 24 hours. Accurate monitoring of intake (oral and IV) and output (vomiting and diarrhea) is imperative. Infants and toddlers should have daily weight measurements obtained.

Antibiotics have no place in the management of rotavirus-induced illness. A number of other therapeutic options have been developed to help control the symptoms of gastrointestinal illnesses. While some may have anecdotal benefit, they are generally not recommended for use in children. These include over-the-counter antimotility drugs (for example, Imodium), which may tend to relieve the frequency and volume of diarrhea as well as lessen associated cramping. Pepto-Bismol is an over-the-counter preparation claiming to lessen the secretory capacity of the intestinal tract. Since it is metabolized to an aspirin-type product, it should not be used in people less than 18 years of age. Some products (for example, Kaopectate) promote their value as adsorbents.

There are some medications that have demonstrated conclusive benefits to control and correct symptoms of rotavirus gastroenteritis. Administration of probiotics (for example, Lactobacillus species) is felt to be helpful in reestablishing the normal intestinal bacterial population. An antiemetic developed to control chemotherapy-induced vomiting (Zofran) has been shown to be safe and effective. Zinc supplementation has also been shown to be effective in controlling diarrhea. The effectiveness is most pronounced when treating children with chronic malnutrition in whom zinc deficiency is most likely to occur.

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