Treatment

There is no cure for rotavirus. Fortunately, most people develop an immune response that is eventually adequate to clear the virus from the body. However, while this natural response develops, the virus wreaks havoc on the body. Considering that the majority of people affected are young infants, the disease state can be particularly dangerous. The most common symptom is diarrhea, and this alone can cause severe dehydration and electrolyte imbalance. For example, sodium concentrations in extracellular fluid have to be maintained between 135 and 150 mmol/liter for proper functioning. When a patient experiences diarrhea, these levels can drop significantly. Therefore, treatments for rotavirus are supportive, aimed at re-hydration to prevent the severe effects of dehydration. Anti-diarrheal medicines are not recommended because they may prolong the infection.

Oral Rehydration Therapy (ORT)

In developing nations, the primary treatment for dehydration is oral rehydration therapy (ORT). In a diarrheal state, levels of sodium (an electrolyte) drop. The normal mechanism for sodium absorption is impaired. Therefore, simply giving saline solution would not work, and excess sodium in the lumen would actually lead to more water secretion and loss. In the 1960's, researchers discovered another possible mechanism for sodium absorption in the diarrheal state. Glucose absorption is not affected by the diarrheal state, and if sodium is given with glucose, the sodium is brought across the intestinal wall via a cotransport mechanism on a 1 to 1 ratio with the glucose. When the sodium concentration in the blood rise, water reabsorption occurs by osmosis. The discovery of this co-transport mechanism has been called "potentially the most important medical advance this century" (Lancet). This discovery led to the development of ORT which was adopted by the World Helth Organization (WHO) in 1978 as its principle strategy for preventing diarrheal deaths.

Contents of oral rehydration salts (ORS) recommended by WHO:

These packets cost only a few cents each. The problem, however is distribution. While it is estimated that ORT is used to treat about half the cases of diarrhea in the developing world, there are still millions of children yet to be reached.

Homemade ORT

In addition to these packets, ORT can be made at home. The ingredients consist of one liter of water, one level teaspoon of salt, and eight level teaspoons of sugar. Proper measurement is important because too much sugar (more than 3%) can worsen diarrhea due to osmotic effects. For these same reasons, children should not be given sports drinks like Gatorade^® to combat dehydration. The high sugar levels in sports drinks can aggravate the diarrhea. Also, these drinks provide the correct electrolytes that adults lose while exercising, but not the ones that children lose by diarrhea. If sugars are not available, starch can be used. Homemade formulas are recommended for people who do not have access to packaged ORS, and can help with the prevention of diarrhea. However, it is not as effective for treatment because it does not contain potassium, another essential electrolyte, or bicarbonate which prevents acidosis. Fortunately, the potassium can be supplied by certains foods, such as bananas. While it is relatively easy to make homemade ORT, the information for doing so has not been distributed to many parents in the developing world. While there are several efforts to disseminate this information (along with the materials), there is still much progress to be made.

Commercial ORS

Oral rehydration salts are also available in the United States and other developed nations. It can be made at home in the same way as described above, but commercial brands are more popular.  The most popular products in the US include Pedialyte^®, Equalyte^®, Ceralyte^®, Enfalyte^®, Rehydralyte^®. For worldwide ORS manufacturers, go here.

Intravenous Fluids

In developed nations such as the United States, severe dehydration caused by rotavirus is often treated with intravenous fluids. A description of a typical IV preparation can be found here.

Researchers at BMC Medicine, after analyzing several studies comparing the effectiveness of ORT and IV administration, have found that there is no discrepancy in the effectiveness of the two alteratives. ORT has several practical advantages over IVs; they are cheaper, less traumatic to the child, easier to administer, and can be given at home. Therefore, ORT is recommended as the first choice in treating dehydration. The American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) also recommend ORT as the first line of therapy for all children with mild to moderate dehydration caused by diarrhea.

Despite this announcement, and the preceeding research, ORT is still largely underutilized in the United States. Physicians overuse intravenous hydration and withold ORT, which is appropriately used in under 30% of diarrhea cases in the United States. There are many possible reasons for this. ORT is perceived as a third world medicine; many insurance providers do not cover ORT; commercial ORT is expensive, ranging from $2-9 per liter. The most important factor, however, is a lack of information and a misperception of the relative benefits of rehydration treatments. [1]