Management Of Acute Gastroenteritis Research Articles

Mortality from Gastroenteritis: Forgotten, but Not Gone

Management of acute gastroenteritis (AGE) in the pediatric population has improved in the last 20 years with the increased use of oral rehydration

Analyse critique de la prescription des antibiotiques au cours des gastroentérites aiguës du nourrisson et du petit enfant

Background. – Antibiotics are usually not recommended in the management of acute gastroenteritis (AGE) in infants. Our study aimed at testing whether our practice was in adequacy with this recommendation. Methods. – We reviewed the files of infants hospitalized for AGE from January 1999 to June 2000. They were sorted into three categories: 1) primary community-acquired AGE; 2) secondary community-acquired AGE; and 3) miscellaneous. Only the cases of primitive AGE were retained for this study in which we compared the characteristics of the patients treated to those who were not given antibiotic treatment. Results. – On the 149 analysed cases, Rotavirus was identified in stools in 94 cases and stool culture was positive in 18 cases. Antibiotics were given to 10% of cases. Treated vs. untreated patients were significantly different for body temperature on admission, maximal body temperature and CRP. Conclusion. – Recommendation not to give antibiotic to infants with AGE was followed in 90% of the cases managed in our department. Antibiotic prescription was dictated by clinical or laboratory signs of severity.

The home management and characteristics of children presenting to hospital with acute gastroenteritis

Large numbers of Australian children are admitted to hospital with acute gastroenteritis. This study aimed to describe the home management of children with acute gastroenteritis prior to presentation at a paediatric hospital. Parents received inadequate information regarding fluid rehydration, particularly from general practitioners, and there was a lack of parental awareness in relation to ORS usage. Children attending childcare were over represented among the sample. The majority of children were only mildly dehydrated on presentation to hospital. Education programs are needed to increase community awareness of ORS and improve home management of acute gastroenteritis.

Management of acute gastroenteritis in Europe and the impact of the new recommendations: a multicenter study. The Working Group on acute Diarrhoea of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.

The European Society for Paediatric Gasteroenterology, Hepatology and Nutrition (ESPGHAN) issued two sets of recommendations for the treatment of infants with acute gastroenteritis (1992, 1997). The purpose of this multicentre study performed in 29 European countries was to determine how closely current treatment compares with the ESPGHAN recommendations. The outline of the study was based on a questionnaire that addressed the management of a 6-month-old infant with acute gastroenteritis complicated by mild to moderate dehydration. National coordinators circulated the questionnaire to randomly selected primary care physicians and to hospital-based paediatricians. A total of 2997 questionnaires were returned, of which 1768 were from Western Europe (WE) and 1229 from Central and Eastern Europe (CEE). Eighty-four percent of responding physicians said they would follow the ESPGHAN recommendation to use oral rehydration solution (ORS) for rehydration, with 66% using an ORS containing 60 mmol/l sodium ORS. Only 16% (WE 15%, CEE 19%) would follow the guidelines and use rapid oral rehydration over 3 to 4 hours. Forty-five percent would rehydrate infants in a 3- to 6-hour period (WE 35%, CEE 60%), and 17% (WE 23%, CEE 9%) would extend the rehydration period to 12 to 24 hours. ESPGHAN recommendation of rapid reintroduction of normal feeding after 3 to 4 hours of oral rehydration would be followed by only 21% of responding physicians, and only 43% (WE 46%, CEE 38%) would start feeding with full-strength formula. However, the guideline about continuation of breast-feeding is widely followed (total 77%; WE 78%, CEE 75%). Thirty-six percent (WE 45%, CEE 23%) use a lactose-containing formula after successful oral rehydration. Contrary to the ESPGHAN guideline 35% (WE 30%, CEE 42%) would use a lactose-free formula and 19% (WE 12%, CEE 28%) a lactose and cow's milk protein-free formula. Only 37% (WE 30%, CEE 46%) of responding physicians would follow the recommendation to use ORS to replace ongoing losses from watery diarrhoea. The results of the survey suggest that with the exception of recommending ORS for rehydration and continuation of breast-feeding during diarrhoea, a minority of responding European physicians follow the ESPGHAN guidelines for optimal management of children with acute gastroenteritis.

Oral Rehydration Therapy for Children with Acute Diarrhea

Childhood diarrhea accounts for a substantial number of primary care visits. Historically, pediatric diarrheal disease was a significant cause of morbidity and mortality in children. Treatment for acute gastroenteritis has changed greatly over the past century, from i.v. therapy to the current use of oral rehydration therapy (ORT). This article highlights the development of ORT, addresses recent ORT controversies, and provides an overview of the current practice guidelines offered by the American Academy of Pediatrics in March 1996 for the management of acute gastroenteritis in children ages 1 month to 5 years.

The Internet as a source for current patient information.

The purpose of this study was to assess the quality of information a lay person could obtain from Internet (Net) sources regarding the treatment of childhood diarrhea. It also afforded an opportunity to evaluate the awareness and compliance of the general medical community with the American Academy of Pediatrics (AAP) guidelines on the management of acute diarrhea. This was a prospective, open, observational, literature review performed with a computer workstation and medical library. The AAP practice parameter on the management of acute gastroenteritis in young children was selected as the current standard by which to judge all other documents. The Net was searched, and all documents retrievable from the first 300 references were evaluated for compliance with current recommendations on the management of diarrhea in children. Of 60 articles published by traditional medical sources, only 12 (20%) conformed to current AAP recommendations for treatment of children. The source of the information, even if from a major academic medical center, did not improve the likelihood of compliance. As demonstrated by information supplied on World Wide Web sites by traditional medical sources, recommendations for the treatment of acute diarrhea show a low percentage of concurrence with the AAP guidelines. Major medical institutions, schools, and hospitals need to devise ways to carefully monitor and establish quality control of what is being distributed from their home pages. Patients must be warned about the voluminous misinformation available on medical subjects on the Net.

Évaluation du traitement ambulatoire des diarrhées aiguës du nourrisson

Gastroenteritis remains a common and expensive illness. Oral rehydration solutions (ORS) have been shown to be effective in the prevention and treatment of dehydration, the prime cause for diarrhea-related morbidity and mortality. To evaluate the ambulatory management of acute gastroenteritis in infants, and particularly practices concerning oral fluid therapy. This prospective, multicenter study included 326 infants (mean age: 10 +/- 6 months), examined in a hospital for acute gastroenteritis, with or without dehydration. Before admission, 81% had previously been examined by a practitioner, and 89% of these practitioners had written a prescription. This prescription included ORS in 35% and was not different according to the age of the infant. Pediatricians prescribed ORS more frequently than general practitioners (respectively 58% vs 29%; P < 0.001). The failure rate of ORS prescription was 25% (two parents did not observe, ten children refused to drink, and eight stopped treatment because of vomiting). Lactose-free milks were prescribed in 46% of infants and the observance was 82%. At least one drug was prescribed in 94% of infants, with a mean of 2.6 drugs per infant; one antibiotic was prescribed in 33% of infants. Infants were admitted to hospital without any previous consultation in 18%, on the parents' initiative but after at least one previous medical examination in 52%, and on the physician's initiative in 30%. Thirty-three percent were dehydrated; one infant died and two had sequellae. The use of ORS remains insufficient. Efforts to improve use of ORS should be expanded beyond physician education.

A Synopsis of the American Academy of Pediatrics’Practice Parameter on the Management of Acute Gastroenteritis in Young Children

A Synopsis of the American Academy of Pediatrics’Practice Parameter on the Management of Acute Gastroenteritis in Young Children

A synopsis of the American Academy of Pediatrics' practice parameter on the management of acute gastroenteritis in young children.

1. Lawrence F. Nazarian, MD* 1. 2. *Associate Editor Chair, Subcommittee on Acute Gastroenteritis This article provides a summary of the practice parameter on gastroenteritis. The reader is urged to refer to the original document for a more thorough presentation.1 Gastroenteritis was chosen as a topic for study because it is a common condition that can cause serious illness and death, especially in younger children. In addition, there is documented variation in how clinicians manage this disorder. Acute gastroenteritis is defined as diarrheal disease of rapid onset, with or without accompanying symptoms and signs such as nausea, vomiting, fever, or abdominal pain. The recommendations apply to children of 1 month to 5 years of age who otherwise are healthy and who live in developed countries. Most patients covered by the guideline will have viral or self-limited bacterial illness; however, the same principles can be applied to patients who have bacterial dysentery or protozoal disease. The clinician managing a patient who has diarrhea must make many decisions, from whether to obtain a stool culture to when the child may return to child care. Three aspects of management were chosen for study, based on their clinical importance as well as the availability of data: rehydration, particularly the role of oral rehydration therapy (ORT); refeeding; and the use of antidiarrheal agents. The parameter was written by a committee consisting of three pediatric gastroenterologists, two pediatric infectious disease specialists, two pediatric epidemiologists, and a practitioner of general pediatrics, who served as chair. The work of the group was guided by the AAP’s Provisional Committee on Quality Improvement A literature search identified more than 4,000 potentially relevant documents, from which 230 were chosen for thorough evaluation. The findings in these articles were subjected to statistical analysis, which served as the basis for the subcommittee’s recommendations. Statistical conclusions were augmented by consensus of the committee members. The document was …

Questions on the Practice Parameter—Gastroenteritis

To the Editor. The recently published practice parameter on management of acute gastroenteritis ( Pediatrics, March 1996) deals effectively with management of dehydration but may have the unintended effect of heightening the risk of dehydration. By advocating a do-nothing approach until or unless signs of dehydration appear, the protocol assumes that severe diarrhea and mild diarrhea can appropriately be managed in an identical fashion in the acute stage, although little evidence is advanced to support this assumption. If signs of dehydration are relied on as the only endpoint for switching to oral rehydration therapy (ORT), unnecessary delays in treatment are implied. Parents may not recognize the early signs of dehydration, and the assignment may unnecessarily switch from maintaining hydration to rehydration. By rejecting nearly every known remedy for acute diarrhea, other than ORT, the pathway guidelines are obviously the product of very strict scientific criteria but may not permit enough empirically derived alternatives. For example, is a meta-analysis of studies of lactose-free formulas sufficient to discount individual, methodologically sound studies that support a significant role for soy-based formulas? And, is it appropriate to reject sports drinks for older children as an alternative to standard ORT solutions, which may not prove to be palatable? (The glucose content of Gatorade is a bit more than ideal and the sodium content is a bit less than ideal.) These measures seem to have been very useful to me over the years. Grown-ups would not think of continuing on a regular diet in the face of severe diarrhea, and it seems counterintuitive to suggest that this course may be appropriate for children. As a pediatric resident in Chicago in the 1960s, one of the most indelible lessons of my training was that the children admitted with severe dehydration from diarrhea were typically children from …

Technical Report Abstract: The Management of Acute Gastroenteritis in Children—Technical Report for the American Academy of Pediatrics Practice Parameter

This technical report describes the process followed in the development of the AAP practice parameter on acute gastroenteritis, as well as the evidence used to formulate the final recommendations. An evidence model that defined acute gastroenteritis and identified diagnostic tests and interventions used in its management and outcomes of importance was used to identify topics to include in the guideline. The three topics selected were: (1) methods of rehydration, (2) refeeding after rehydration, and (3) the use of antidiarrheal agents. Primary outcomes of interest were duration of disease, complications of therapy, parental satisfaction, and cost. Multiple bibliographic sources were searched to identify articles related to these areas; the sources included MEDLINE, reports on gastroenteritis from the Centers for Disease Control and Prevention and the World Health Organization, the Federal Register, a report to the Food and Drug Administration, and files of the expert panel. More than 4000 articles were initially reviewed, of which 230 were identified as being potentially related to the three topics. Qualitative aspects of the literature reviewed were summarized in evidence tables. Sufficient data for quantitative summary were available only for refeeding after rehydration. In this analysis, the weighted difference across studies between treatment and control groups in the mean duration of diarrhea was used as the measure of the relative benefit of one form of therapy over another. Methods of Rehydration Evidence comparing oral rehydration and intravenous therapy was limited to five reports of randomized trials conducted in developed countries. It was not possible to perform a quantitative synthesis of this information because of a lack of similar outcomes.

Pre-admission management of acute gastroenteritis.

Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre-admission management of children admitted with acute gastroenteritis to a major children's hospital. Information was obtained from parental questionnaires and the medical notes for 164 children. Parents were poorly informed regarding appropriate home management. Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%, and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%), antidiarrhoeals (1.2%) and anti-emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance. Oral rehydration therapy is utilized rarely and medications are over-utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management. The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.

Comparison of three regimens in the management of acute gastroenteritis in infants

Sixty infants were randomly assigned to one of three groups on admission to hospital with a diagnosis of gastroenteritis. After rehydration, Group A received a low-lactose, low-fat feed (HN25) in full strength; Group B were regarded on to a conventional formula (SMA); Group C received a hydrolysed soya and collagen feed (Prejomin) in full strength. All feeds were continued for 5 days. The median duration of loose stools from starting the feed was 24 hours in Group A, compared to 119 hours and 95 hours in Groups B and C, respectively. Group A showed a mean percentage increase in weight of 2.34%, Group B showed a mean loss of 1.45%, and Group C a mean increase of 0.15%. These differences were statistically significant. Recovery from gastroenteritis is hastened by the use of a low-lactose, low-fat feed in the initial post-rehydration phase of the disease.

Clinical presentation and management of acute gastro-enteritis in in-patient children at King Khalid University Hospital, Riyadh, Saudi Arabia

In a retrospective survey, case notes of all children with acute gastro-enteritis (AGE) admitted to our hospital between 1984 and 1988 were reviewed. The total number of cases was 300. The mean age was 14 months (range 1-60 mths): 67% of cases were boys and 33% girls. Eleven per cent were exclusively breastfed. The clinical presentation was diarrhoea and vomiting in 81%, diarrhoea alone in 15%, and vomiting primarily in 4%. All children had good nutritional status, i.e. both their height and weight were between the 5th and 90th percentile for their age and none showed signs of marasmus or kwashiorkor. Forty-six per cent of the children had AGE without dehydration. Mild, moderate and severe dehydration was present in 41%, 10% and 3% of cases, respectively. Isotonic, hypotonic and hypernatraemic dehydration was present in 95%, 3% and 2% of cases of dehydration, respectively. Sixty-five per cent of cases were given intravenous (IV) fluids. The mean duration of IV administration was 1 day, with a range of 1-7 days. Twenty-two per cent of the children were given oral rehydration solution (ORS) initially, and 13% were given IV plus ORS. None of the children died of gastro-enteritis. It is concluded that there was excessive use of IV fluids, and that there is an urgent need to encourage the use of ORS.

Comparison of oral sucrose and glucose electrolyte solutions in the out-patient management of acute gastroenteritis in infancy

Seventy-three children under the age of 18 months presenting with acute gastroenteritis were given an electrolyte mixture with added sucrose or glucose in a randomized double-blind trial. The time taken to recovery in those sucessfully treated as out-patients was identical. However, of the 34 who received glucose, 11 (32%) required admission compared with 7 (18%) of the 39 who received sucrose. There was a wide range of osmolality of the made-up feeds, indicating inaccuracy in diluting the solutions as prescribed, but this did not in general correlate with need for admission. Sucrose-electrolyte solution is at least as effective as a glucose-electrolyte solution for the out-patient management of acute gastroenteritis in infancy. The cheapness and easy availability of sucrose commends its use in developed and developing countries.