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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