Stomach Flu Treatments and Medications

What exactly is stomach flu? A bewildering variety of digestive system problems are all called “stomach flu” or “stomach bug”—intestinal infections, parasites, food allergies, food poisoning. However, when it comes to stomach flu outbreaks, the offender is mostly commonly a virus, referred to as viral gastroenteritis.

What is the stomach flu?

Viral gastroenteritis (“stomach flu” or “stomach bug”) is a viral infection of the stomach and intestines that causes diarrhea, nausea, vomiting, stomach pain, and abdominal cramping. While most cases resolve in a few days without serious problems, viral gastroenteritis can be a serious and even life-threatening infection in very young children, seniors, or people with immune system problems.

Several different viruses can cause stomach flu, but nine in ten cases are caused by norovirus. Rotavirus is usually the culprit when young children come down with stomach flu, but rotavirus vaccines have drastically reduced the incidence in the United States. Other viruses, such as adenovirus (the cold virus), astrovirus, and sapovirus, are responsible for a small number of cases, chiefly among infants and children. The influenza virus, however, never causes stomach flu, so a flu shot does not help prevent stomach flu.

Bacteria can also cause gastroenteritis, most commonly Shigella, Salmonella, Campylobacter, and E. coli. Treatment and medications for bacterial gastroenteritis are covered more fully in their own articles.

Viral gastroenteritis often occurs in outbreaks. Closed communities such as long-term care facilities, daycare centers, schools, prisons, and cruise ships are particularly vulnerable to outbreaks. Gastroenteritis viruses spread from person to person primarily through what is called the fecal-oral route. This occurs when microscopic fecal contaminants are incidentally ingested. Contaminated food is the most common cause of infection, particularly food that is served raw, washed in contaminated water, or handled after being cooked. However, people can pick up infected fecal material from person-to-person contact, clothes, furniture, utensils, or even floating in the air.

Norovirus is a particularly contagious, tough, and long-lasting virus. It can survive extreme heat and freezing cold, withstand many disinfectants, and survive on surfaces for up to two weeks. For this reason, norovirus is responsible for over half of all foodborne outbreaks. About 21 million people in the United States get sick and nearly 800 people die from norovirus infection each year.

An additional 3 million cases of viral gastroenteritis—almost all infants or very young children—are caused by rotavirus. Most adults and older children, however, are immune to rotavirus. Anyone can catch stomach flu, but infants, young children, seniors, and people with compromised immune systems are at a higher risk for infection. Other risk factors include eating out frequently, attending a daycare center or school, living in a nursing home, or staying in cruise ships, hotels, or other partly-closed communities. Poor handwashing habits also increase the likelihood of a gastrointestinal viral infection.

Most cases of viral gastroenteritis typically resolve in a few days. Treatment consists mainly of supportive care. Dehydration is the most serious complication, so supportive care mainly focuses on maintaining sufficient hydration. Medications can help with nausea, vomiting, or diarrhea. However, infants, the elderly, and people with compromised immune systems may require hospitalization.

How is the stomach flu diagnosed?

Stomach flu is primarily diagnosed through a physical examination and a patient medical history. Most cases will be diagnosed and treated by a general practitioner.

Symptoms are the best guide for diagnosis. The defining symptom of stomach flu is loose or watery diarrhea, but other symptoms might include.

• Nausea

• Vomiting

• Abdominal pain

• Low-grade fever

Loss of appetite, involuntary weight loss, and bloating might also be experienced.

Symptoms of gastroenteritis usually start suddenly (or ‘acutely’, hence the term ‘acute gastroenteritis’), coming on in one or two hours. In addition to how quickly symptoms started, a healthcare provider will want to know:

• How long have you had symptoms?

• Do other people you know have similar complaints?

• Did you eat anything unusual recently, such as raw foods?

• Did you travel recently, especially outside the country?

A physical examination will help the healthcare professional rule out other conditions. The healthcare provider will carefully look for signs of dehydration, such as sunken eyes, limpness, dry mucous membranes (inside the mouth), loose skin, or drowsiness.

Blood or stool tests are not necessary to diagnose viral gastroenteritis, but a healthcare provider will use them to rule out other causes, such as a bacterial infection, parasite infection, or other intestinal problems. Blood or urine tests may be necessary if there are signs of dehydration.

Stomach flu treatment options

Most cases of viral gastroenteritis resolve on their own, typically in one to three days, depending on the virus. Treatment of viral gastroenteritis focuses entirely on managing symptoms, particularly dehydration. Bacterial gastroenteritis, the subject of other articles, is treated with both antibiotics and symptom support.

Supportive care

The primary focus of supportive care is to maintain hydration and electrolytes. Drinking fluids or using over-the-counter oral rehydration solutions (ie, Pedialyte, Gatorade, Powerade) are the principal treatments. IV fluids and hospitalization may be required for more severe dehydration.

Medications

Over-the-counter or prescription medications can provide symptom relief for nausea, vomiting, or diarrhea. Antibiotics fight bacteria (not viruses), so while they are effective against bacterial gastroenteritis, they are not effective against the viruses that cause stomach flu.

Medicine

Viral gastroenteritis typically resolves in a few days without medical intervention. Over-the-counter medications can help manage stomach flu symptoms such as dehydration, nausea, vomiting, and diarrhea. Severe cases, though, may require more powerful prescription medications to prevent serious dehydration.

Oral rehydration solutions

Oral rehydration solutions such as Pedialyte, Hydralite, or Ensure Rapid Hydration, replace fluids and electrolytes lost to vomiting or diarrhea. The electrolytes in many commercially available oral rehydration solutions are balanced to ensure the most effective fluid absorption. While commercially available oral rehydration solutions are better than sports drinks, a combination of ice and water is usually sufficient for handling mild gastroenteritis.

Antiemetics

Antiemetics (anti-nausea medications agents) reduce nausea and vomiting by slowing down the part of the brain responsible for nausea and the vomiting reflex. For mild gastroenteritis, over-the-counter antiemetics such as dimenhydrinate or meclizine are usually sufficient to keep nausea and vomiting in check. If severe dehydration is a problem, a doctor or emergency room physician may use a more potent prescription antiemetic such as ondansetron, metoclopramide (reduces nausea and vomiting by making the stomach contract), or prochlorperazine. These drugs may initially be administered intravenously.

Antidiarrheal agents

As a general rule, people with mild gastroenteritis who can stay hydrated shouldn’t take antidiarrheal drugs. If dehydration or severe diarrhea is an issue, however, over-the-counter antidiarrheal agents can help. Antimotility agents such as loperamide, work by slowing down the colon. Bismuth salts (bismuth subsalicylate) coat the intestinal tissues and prevent water and electrolytes from being secreted into the stools. Both types of drugs let fecal material build up in stools before being passed.

Choosing the best medication

Medications only treat stomach flu symptoms, but most people can endure a bout of stomach flu without medications. There is, then, no “best” medication for stomach flu, only a combination of drugs that decreases the risk of complications, reduces discomfort, and has a minimum of unpleasant side effects.

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Best medications for the stomach flu