Gastroenteritis prescription

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I now have excellent content from multiple authoritative textbooks. Here is a thorough gastroenteritis prescription guide:

Gastroenteritis - Prescription & Management Guide

Note: This is for educational purposes. Always individualize therapy based on patient age, severity, pathogen, and local resistance patterns.

1. Severity Assessment First

Severity	Features	Setting
Mild	<3 stools/day, no fever, no blood, tolerating fluids	Outpatient
Moderate	3-6 stools/day, mild fever, some dehydration	Outpatient/ED
Severe	>6 stools/day, high fever, bloody stool, unable to drink, signs of shock	Hospitalize

2. Rehydration (CORNERSTONE of Treatment)

Oral Rehydration Therapy (ORT) - first-line for mild-moderate dehydration:

WHO/UNICEF ORS formula: 3.5 g NaCl + 2.5 g NaHCO₃ + 1.5 g KCl + 20 g glucose per 1 L water
Home formulation (adults): ½ tsp salt + 6 level tsp sugar in 1 L clean water
Commercial: Pedialyte, Electral sachets

Dosing (ORS volumes):

Mild dehydration: 30-50 mL/kg over 4 hours
Moderate dehydration: 60-80 mL/kg over 4 hours
Replace each loose stool with 10 mL/kg extra; each vomit with 2 mL/kg extra

IV hydration (severe / unable to tolerate oral):

Ringer's Lactate or Normal Saline 20 mL/kg IV bolus; repeat as needed
Switch to ORS once tolerating orally

(Goldman-Cecil Medicine, p. 2973; Rosen's Emergency Medicine, p. 3107)

3. Symptomatic Medications

Anti-diarrheal (Antimotility)

Only for non-bloody, non-febrile watery diarrhea in adults:

Drug	Adult Dose	Notes
Loperamide	4 mg initially, then 2 mg after each loose stool; max 16 mg/day	Avoid with fever, bloody stool, or suspected STEC
Bismuth subsalicylate	524 mg (2 tabs) every 30-60 min as needed; max 8 doses/day (4,200 mg/day)	Also for vomiting/nausea

Anti-emetic

Drug	Dose
Ondansetron	4-8 mg PO/IV every 8 hours (adults); 0.15 mg/kg in children
Metoclopramide	10 mg PO/IV TDS
Domperidone	10 mg PO TDS (before meals)

(Harrison's, Table 138-5; Goldman-Cecil, Table 26-5)

4. Zinc Supplementation (Children)

Children <6 months: Zinc 10 mg/day for 14 days
Children >6 months: Zinc 20 mg/day for 14 days
Shown to decrease severity, duration, and recurrence of diarrhea

(Goldman-Cecil Medicine, p. 2973)

5. Antibiotic Therapy

Most acute gastroenteritis is viral and self-limiting - antibiotics are NOT routinely indicated.

Indications for Antibiotics:

Dysentery (bloody diarrhea) with or without fever
Fever >37.8°C with suspected invasive infection
Immunocompromised patients
Severe traveler's diarrhea
Specific pathogens (C. difficile, Giardia, E. histolytica, Shigella, Campylobacter)

Empirical Antibiotic Regimens (Adults):

Indication	Drug	Dose
Empirical (acute/invasive)	Azithromycin	1 g single dose PO, OR 500 mg once daily x 3 days
	Ciprofloxacin	500 mg PO q12h x 3 days
	Levofloxacin	500 mg PO once daily x 3 days
Traveler's diarrhea (non-invasive)	Rifaximin	200 mg PO TDS x 3 days
	Azithromycin	1 g single dose PO
C. difficile	Metronidazole	500 mg PO TDS x 10-14 days (mild-moderate)
	Vancomycin	125 mg PO QDS x 10-14 days (severe)
Giardia	Metronidazole	400-500 mg PO TDS x 5-7 days
	Tinidazole	2 g single dose PO
E. histolytica (amoebic)	Metronidazole	750 mg PO TDS x 5-10 days, then diloxanide furoate

⚠️ Do NOT use antibiotics in:

Suspected STEC / E. coli O157:H7 (increases risk of HUS - hemolytic uremic syndrome)
Uncomplicated non-bloody diarrhea without fever

(Goldman-Cecil Medicine, Table 26-5; Harrison's, Table 138-5)

6. Specific Pathogen Treatment (Children, per Rosen's)

Pathogen	First-line
Salmonella (non-typhi, high-risk*)	Ceftriaxone 50-75 mg/kg IV/IM or Ciprofloxacin 20-40 mg/kg/day divided q12h
Salmonella typhi	Ceftriaxone 50-75 mg/kg q24h x 10-14 days
Shigella	Ceftriaxone 50 mg/kg IV x 5 days (severe), or Azithromycin PO (mild)
Campylobacter	Azithromycin 10 mg/kg/day x 3 days
Giardia	Metronidazole 15 mg/kg/day TDS x 5-7 days, or Tinidazole 50 mg/kg x 1
C. difficile	Metronidazole or Vancomycin PO

High-risk children = <3 months old, immunosuppressed, hemoglobinopathies, HIV, chronic GI disease

7. Diet and Feeding

Do NOT fast - continue age-appropriate diet as soon as vomiting subsides
BRAT diet (Bananas, Rice, Applesauce, Toast) is acceptable but not mandatory
Continue breastfeeding in infants
Avoid high-sugar drinks (fruit juice, sodas) which worsen osmotic diarrhea
Lactose restriction only if clinically significant lactose intolerance is triggered

8. Sample Outpatient Prescription (Adult, Mild-Moderate Traveler's Diarrhea)

Rx:
1. ORS sachets - dissolve in 1L water - sip 200-400 mL after each loose stool
2. Tab. Loperamide 2 mg - 2 tabs stat, then 1 tab after each loose stool (max 8 tabs/day) x 2 days
3. Tab. Azithromycin 500 mg - 1 tab once daily x 3 days (if symptoms moderate or not improving)
4. Tab. Ondansetron 4 mg - 1 tab TDS as needed for nausea/vomiting
5. Tab. Zinc 20 mg - once daily x 14 days (for children)
6. Advise: Resume normal diet, avoid dairy if worsens, return if bloody stool/high fever/unable to tolerate fluids

9. Warning Signs - Refer/Hospitalize if:

Signs of severe dehydration (sunken eyes, no urine >6 hrs, altered consciousness)
Bloody or mucoid stool with high fever
Unable to tolerate any oral fluids
Symptoms lasting >7 days without improvement
Age extremes (infants <6 months, elderly >65)
Immunocompromised patients

Sources: Goldman-Cecil Medicine (Table 26-5, p. 2973) | Harrison's Principles of Internal Medicine 22E (Table 138-5) | Rosen's Emergency Medicine (pp. 3091-3113) | Tintinalli's Emergency Medicine

Prescrption - Acute Gastroenteritis that requires 6 days of rest

Here is a complete medical prescription for Acute Gastroenteritis with a 6-day rest certificate:

🏥 MEDICAL PRESCRIPTION

Date: 06 / 08 / 2026 Diagnosis: Acute Gastroenteritis (ICD-10: A09) Rest Advised: 6 Days (06 Aug 2026 – 11 Aug 2026)

Rx

💧 1. Rehydration (Priority #1)

ORS (Oral Rehydration Salts)

Dissolve 1 sachet in 1 litre of clean water
Take 200–300 mL after every loose stool and episode of vomiting
Continue throughout the day until diarrhea stops
Qty: 10 sachets

🛑 2. Anti-diarrheal

Tab. Loperamide 2 mg

2 tablets stat (immediately), then
1 tablet after each loose stool
Maximum: 8 tablets per day
Do NOT take if stool is bloody or if fever >38°C
Duration: up to 3 days or until stools normalize
Qty: 20 tablets

🤢 3. Anti-emetic

Tab. Ondansetron 4 mg

1 tablet every 8 hours as needed for nausea/vomiting
Take 30 minutes before meals
Duration: 3–4 days
Qty: 12 tablets

🦠 4. Antibiotic (Moderate Severity)

Tab. Azithromycin 500 mg

1 tablet once daily (morning, after food)
Duration: 3 days
Qty: 3 tablets

🔥 5. Antipyretic / Analgesic (for fever & cramps)

Tab. Paracetamol 500 mg

1–2 tablets every 6–8 hours as needed for fever or abdominal discomfort
Do not exceed 4 g (8 tablets) per day
Duration: as required
Qty: 20 tablets

⚡ 6. Zinc Supplementation (if child or nutritional depletion)

Tab. Zinc Sulfate 20 mg

1 tablet once daily
Duration: 14 days
Qty: 14 tablets

🌿 7. Probiotic (Gut Flora Restoration)

Cap. Lactobacillus (Sporolac / Vizylac)

1 capsule twice daily after meals
Duration: 6 days
Qty: 12 capsules

📋 General Instructions

#	Instruction
1	Complete bed rest for 6 days — avoid physical exertion, travel, and work
2	Drink at least 2.5–3 litres of fluids per day (ORS, water, clear soups, coconut water)
3	Diet: Light, bland food — rice porridge (khichdi), boiled rice, banana, toast, boiled potato
4	Avoid: Spicy food, oily food, raw vegetables, dairy products, alcohol, caffeinated drinks
5	Do not self-medicate with NSAIDs (ibuprofen, aspirin) — these irritate the GI tract
6	Take antibiotics (Azithromycin) with or after food to reduce nausea
7	Maintain hand hygiene — wash hands before eating and after using the toilet
8	Return immediately if: bloody stools, high fever (>39°C), inability to retain any fluids, severe abdominal pain, signs of dehydration (no urine >6 hrs, dizziness)

🚨 Red Flag Symptoms - Seek Emergency Care If:

Bloody or black tarry stools
High fever not responding to paracetamol
Severe, worsening abdominal pain
No urine output for more than 6 hours
Confusion, extreme weakness, or fainting

🛌 FITNESS / REST CERTIFICATE

This is to certify that the above-named patient has been examined and is suffering from Acute Gastroenteritis. The patient requires complete rest and is advised to abstain from work / school / physical activity for a period of SIX (6) DAYS from 06 August 2026 to 11 August 2026 (inclusive).

Follow-up: After 6 days, or earlier if symptoms worsen.

⚠️ Disclaimer: This prescription template is for educational/reference purposes. All prescriptions must be issued by a licensed and registered medical practitioner after clinical examination of the patient.

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