Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

被引:48
作者
Freedman, Stephen B. [1 ,2 ]
Pasichnyk, Dion [3 ]
Black, Karen J. L. [4 ]
Fitzpatrick, Eleanor [5 ]
Gouin, Serge [6 ]
Milne, Andrea [3 ]
Hartling, Lisa [3 ]
机构
[1] Univ Calgary, Alberta Childrens Hosp, Res Inst, Cumming Sch Med,Sect Pediat Emergency Med, Calgary, AB, Canada
[2] Univ Calgary, Alberta Childrens Hosp, Res Inst, Cumming Sch Med,Sect Gastroenterol, Calgary, AB, Canada
[3] Univ Alberta, Dept Pediat, Alberta Res Ctr Hlth Evidence, Edmonton, AB, Canada
[4] Univ British Columbia, BC Childrens Hosp, Div Pediat Emergency Med, Vancouver, BC V5Z 1M9, Canada
[5] Dalhousie Univ, Dept Emergency Med, Emergency Dept, IWK Hlth Ctr, Halifax, NS, Canada
[6] Univ Montreal, Ctr Hosp Univ Ste Justine, Sect Pediat Emergency Med, Montreal, PQ, Canada
来源
PLOS ONE | 2015年 / 10卷 / 06期
基金
加拿大健康研究院;
关键词
RANDOMIZED CLINICAL-TRIAL; ACUTE INFECTIOUS DIARRHEA; ORAL ONDANSETRON; PEDIATRIC GASTROENTERITIS; LACTOBACILLUS GG; CHILDREN; INFANTS; HETEROGENEITY; REHYDRATION; GUIDELINES;
D O I
10.1371/journal.pone.0128754
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Context Gastroenteritis remains a leading cause of childhood morbidity. Objective Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected. Data Sources MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings. Study Selection Randomized controlled trials, conducted in developed countries, of children aged < 18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate. Data Extraction The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models. Results 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95% CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95% CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95% CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95% CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92). Conclusions There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge.
引用
收藏
页数:21
相关论文
共 56 条
[1]   Bacterial Enteropathogens and Risk Factors Associated with Childhood Diarrhea [J].
Al Jarousha, Abdel Moati Kh. ;
El Jarou, Mahmoud A. ;
El Qouqa, Iyad A. .
INDIAN JOURNAL OF PEDIATRICS, 2011, 78 (02) :165-170
[2]   Probiotics for treating acute infectious diarrhoea [J].
Allen, Stephen J. ;
Martinez, Elizabeth G. ;
Gregorio, Germana V. ;
Dans, Leonila F. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (11)
[3]  
[Anonymous], NAT COLL CTR WOM CHI
[4]  
[Anonymous], 2001, SYSTEMATIC REV HLTH
[5]  
[Anonymous], PLOS MED
[6]  
[Anonymous], CHILD HLTH CAR QUAL
[7]  
[Anonymous], BMJ OPEN
[8]  
[Anonymous], ANN EMERG MED
[9]  
[Anonymous], 2013, ALIMENT PHARM THER, DOI DOI 10.1111/apt.12163
[10]  
[Anonymous], COMP MACR CONT REG G