Treatment Of Acute Diarrhea In Children Research Articles

Lactobacillus GG for Treatment of Acute Childhood Diarrhoea

Lactobacillus GG for Treatment of Acute Childhood Diarrhoea

Bacillus clausii for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Acute diarrhea is a burdensome disease with potentially harmful consequences, especially in childhood. Despite its large use in clinical practice, the efficacy of the probiotic Bacillus clausii in treating acute childhood diarrhea remains unclear. Our objective was to systematically review the efficacy of Bacillus clausii in the treatment of acute childhood diarrhea. The following electronic databases were systematically searched up to October 2017: MEDLINE (via PubMed/OVID), EMBASE (via OVID), Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and ClinicalTrials.gov. Only randomized controlled trials were included. The overall effect for the meta-analysis was derived by using a random effects model. Six randomized controlled trials (1298 patients) met the eligibility criteria. Data arising from pooled analysis showed that Bacillus clausii significantly reduced the duration of diarrhea (mean difference = −9.12 h; 95% confidence interval [CI]: −16.49 to −1.75, p = 0.015), and the duration of hospitalization (mean difference = −0.85 days; 95% CI: −1.56 to −0.15, p = 0.017), compared with control. There was a trend of decreasing stool frequency after Bacillus clausii administration compared with the control group (mean difference = −0.19 diarrheal motions; 95% CI: −0.43 to −0.06, p = 0.14). Bacillus clausii may represent an effective therapeutic option in acute childhood diarrhea, with a good safety profile.

Efficacy and safety of diosmectite in acute childhood diarrhoea: a meta-analysis

ObjectiveWe evaluated the role of diosmectite as an add-on treatment to the ‘recommended treatment’ of acute diarrhoea in children.MethodsWe searched all published literature through the major databases: Medline via Ovid,...

Traditional Yoghurt and Probiotic in Treatment of Acute Childhood Diarrhoea: A Blinded Randomized Controlled Non - Inferiority Trial

Background: Diarrhoeal diseases rank with acute respiratory infections as among the major causes of morbidity and mortality among children under 5 years of age. Probiotics has been used in the diarrheal episode and have been proved to be useful. The traditional Indian yoghurt which is easily available at all places is being used in Indian villages during episode of diarrhoea. There is only one study comparing the efficacy of yoghurt with probiotics and this study was done tocompare the efficacy and cost effectiveness of traditional yoghurt and probioticin the treatment of acute childhood diarrhoea. Material and Methods: Children aged between three months to five years admitted with some dehydration due to acute diarrhoea were included. Children were randomised in to two groups comprising of 50 cases in each group, intervention group received traditional yoghurt and control received market available probiotic. Results: Data was analysed with the help of SPSS version 16 and the continuous data were compared by Students 't' test. The chi-squared test or Fischer's exact test was used to test the difference between groups and statistical significance was considered as p ≤ 0.05. There was no significant difference between probiotic and traditional yoghurt when time of appearance of first semi formed stool {46.70 ± 14.40 Vs 50.64 ± 13.40 hours}, amount of stool passed per 24 hours {155.74 ± 74.27 Vs 167.53 ± 109.58 grams}, mean numbers of stools {6.29 ± 1.94 Vs 7.22 ± 2.63} and mean weight gain {121.94 ± 94.21 Vs 113.29 ± 73.85 grams} were compared. However, treatment cost with traditional yoghurt was almost half (7.20 Indian Rupees (INR) /patient/day) as compared to Probiotics (15.60INR/patients/ day). Conclusion: Traditional yoghurt was equally efficacious to probiotics and the relative cost of traditional yoghurt was less than probiotic and is easily available at all places especially in the villages and rural areas of tropical countries.

Traditional Yoghurt and Probiotic in Treatment of Acute Childhood Diarrhoea: A Blinded Randomized Controlled Non - Inferiority Trial

Traditional Yoghurt and Probiotic in Treatment of Acute Childhood Diarrhoea: A Blinded Randomized Controlled Non - Inferiority Trial

Should Probiotics be Used in the Treatment of Acute Childhood Diarrhea?

Department of Pediatrics All India Institute of Medical Sciences (AIIMS) New Delhi India The author declares that he has nothing to disclose.

Should Probiotics be Used in the Treatment of Acute Childhood Diarrhea?

Should Probiotics be Used in the Treatment of Acute Childhood Diarrhea?

The added benefit of zinc supplementation after zinc treatment of acute childhood diarrhoea: a randomized, double-blind field trial

To determine whether continuing with zinc supplementation after zinc treatment (ZT) of an acute diarrhoea episode will result in additional clinical benefits beyond ZT alone. Children 6-23 months of age, living in an urban slum in Dhaka, Bangladesh with acute childhood diarrhoea (ACD), were enrolled in a randomized, double-blind field trial. All children received 10 days of ZT (20 mg/day) and were then randomized to zinc (10 mg/day) or placebo supplementation for 3 months. Weekly follow-up of all children occurred over a period of 9 months. A total of 353 subjects were enrolled, with 93% of the zinc supplemented and 96% of the placebo children followed for 9 months. The incidence density of ACD among those receiving zinc supplementation compared to those receiving placebo was reduced by 28% (2.64 vs.3.66 episodes/p-y follow-up) over the 3 months while on supplementation and by 21% (2.05 vs.2.59 episodes/p-y follow-up) over the 9 months of follow-up. There was no observed effect on the incidence of acute respiratory infections (ARIs) or on growth. Zinc supplementation after treatment provides additional preventive ACD benefits to children in early childhood. Larger, effectiveness trials of this strategy are warranted.

A Prospective Multicentric Observational Study to Evolve the Usefulness of the Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children

Background & objectives: Acute diarrheal disease is one of the major causes of morbidity and mortality in developing countries. No data regarding the pediatric population suffering from acute diarrhea seeking homoeopathic treatment in India are available. Therefore, an observational study on acute diarrheal diseases in children was undertaken with 14 predefined trial homoeopathic medicines to arrive at a group of useful homeopathic medicines for the treatment of acute childhood diarrhea. Methods: A prospective, multi-centre observational study was conducted by Central Council for Research in Homeopathy at its various Institutes and Units throughout India during Oct. 2005- Sept. 2008. A total of three hundred twenty seven children in the age-group, 6 months to 12 years, were included. Trial medicines selected on the principles of Homeopathy were prescribed and the diarrhea index score was assessed before and after treatment using SPSS (ver. 16). Results: The difference in the mean number of stools and diarrhea index score was found to be statistically significant (p=0.000, <0.05) after the prescription of trial homoeopathic medicines in 321 children. The diarrhea index score got either worsened or remained unchanged from the baseline score in 6 (1.83%) children. Of the 14 medicines half of them viz.,Podophyllum peltatum (n=158), Chamomilla (n=49), Aethusa cynapium (n=25), Mercurius solubilis (n=23), Calcarea carbonica (n=21), Sulphur (n=18), and Phosphorus (n=17) were found to be most useful among the 14 predefined trial medicines. Conclusion: This was an observational study with positive results leads to further validation by suitable Randomized Control Trial(s).

Homeopathic Combination Remedy in the Treatment of Acute Childhood Diarrhea in Honduras

Despite the widespread availability of oral rehydration therapy, diarrheal illness remains a major cause of morbidity and mortality around the world. Previous studies have shown individualized homeopathic therapy to be effective in treating childhood diarrhea, but this approach requires specialized training. A homeopathic combination medicine, if effective, could be used by health personnel on a widespread basis. A double-blind randomized controlled trial was conducted in Honduras to evaluate the effectiveness of a homeopathic combination therapy to treat acute diarrhea in children. A total of 292 children with acute diarrhea was recruited; 145 were randomized to the experimental group and 147 to the placebo group. Tablets containing a combined preparation of the five most common single homeopathic remedies used to treat diarrhea or placebo were administered by a parent after each unformed stool. Children were followed up daily for 7 days or until symptoms resolved, whichever occurred first. Time until resolution of symptoms, daily rate of unformed stools, and total number of unformed stools were compared between the two groups. There was no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups (hazard ratio = 1.02, 95% confidence interval: 0.79-1.32), with a median time until resolution of 3 days for both groups. Children in the treatment group had an average of 2.6 unformed stools per day compared to 2.8 among those in the placebo group; this difference was not significant (p = 0.43). The median number of unformed stools was 7 among children in the treatment group and 8 among those in the placebo group (p = 0.41). The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children. Further study is needed to develop affordable and effective methods of using homeopathy to reduce the global burden of childhood diarrhea.

Acceptability of and adherence to dispersible zinc tablet in the treatment of acute childhood diarrhoea.

Zinc treatment is now recommended by the World Health Organization as part of the routine management of acute childhood diarrhoea. A dispersible zinc tablet formulation was developed taking into account the taste, cost, and feasibility to distribute and store. Only limited information is available on the acceptability of and adherence to dispersible zinc tablet. No study has formally assessed whether the formulation is acceptable to children and if caretakers can adhere to the instructions regarding preparation, dosage, and duration of treatment. This community-based study aimed at determining the acceptability of and adherence to a dispersible zinc tablet formulation in a cohort of children (n=320) aged less than five years. Caretakers of children with acute childhood diarrhoea were prescribed zinc tablet treatment and followed up after 2-3 weeks. The formulation was acceptable to children; 90.1% of 303 caretakers perceived that the tablets were equally or even more acceptable to their children compared to other medicines. Ninety-eight percent of the children received the standard dose of one tablet per day, and 55.8% completed the full 10-day course of zinc treatment. Adherence rates did not vary by age or gender of the child. These findings indicate that the tablet formulation is acceptable, but further efforts are required to enhance adherence.

Effects of Saccharomyces boulardii in children with acute diarrhoea

Certain probiotic agents, e.g. Lactobacillus GG, have shown efficacy in clinical trials for the treatment of acute childhood diarrhoea, but few studies have examined the effect of Saccharomyces boulardii. We evaluated the effect of S. boulardii in children with acute diarrhoea. Two hundred children were randomized to receive S. boulardii in a granulated form in a daily dose of 250 mg (S. boulardii group) or placebo (placebo group) for 5 d. Clinical and demographic characteristics on admission were similar between the study groups. The medians of the average stool frequency after the second day of the treatment were significantly lower in the S. boulardii group than in the placebo group (p = 0.003). The duration of diarrhoea significantly reduced in the S. boulardii group compared with the placebo group (4.7 vs 5.5 d, p = 0.03). The effect of S. boulardii on watery diarrhoea became apparent after the second day of the treatment. The duration of hospital stay was shorter in the S. boulardii group than in the placebo group (2.9 vs 3.9 d, p < 0.001). Four children from the placebo group versus only one child from the S. boulardii group had persisting diarrhoea. The placebo-controlled study suggested that S. boulardii significantly reduced the duration of acute diarrhoea and the duration of hospital stay. S. boulardii seems to be a promising agent for the amelioration of the course of acute diarrhoea in children when used therapeutically.

How will the scaling up of zinc for treatment of childhood diarrhoea affect caretakers' practices?

It is now one decade since the publication of the landmark randomized clinical trial results by Sazawal et al. demonstrating the efficacy of zinc in the treatment of acute childhood diarrhoea. Since that time several hospital and community-based randomized trials have consistently shown that zinc is an effective treatment for either acute or persistent diarrhoea in children aged less than five years. Benefits include shortened duration of illness episodes reduced likelihood of an episode of prolonged (<7 days) or persistent (<14 days) diarrhoeal illness and following recovery a decreased likelihood of a repeat episode over the next three months. Over this same period of time risk for non-injury death has been estimated to be reduced by 50%. On the basis of these findings the United Nations Childrens Fund (UNICEF) and the World Health Organization (WHO) jointly issued a statement in May 2004 recommending that all children with a diarrhoeal illness be treated by zinc. It is estimated that the successful implementation of this recommendation has the potential to save nearly 400000 lives annually. (excerpt)

Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries.

To analyse the incremental costs, effects and cost-effectiveness of zinc used as adjunct therapy to standard treatment of acute childhood diarrhoea, including dysentery, and to reassess the cost-effectiveness of standard case management with oral rehydration salt (ORS). A decision tree was used to model expected clinical outcomes and expected costs under four alternative treatment strategies. The best available epidemiological, clinical and economic evidence was used in the calculations, and the United Republic of Tanzania was the reference setting. Probabilistic cost-effectiveness analysis was performed using a Monte-Carlo simulation technique and the potential impacts of uncertainty in single parameters were explored in one-way sensitivity analyses. ORS was found to be less cost-effective than previously thought. The use of zinc as adjunct therapy significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness. The results were particularly sensitive to mortality rates in non-dysenteric diarrhoea, but the alternative interventions can be defined as highly cost-effective even in pessimistic scenarios. There is sufficient evidence to recommend the inclusion of zinc into standard case management of both dysenteric and non-dysenteric acute diarrhoea.A direct transfer of our findings from the United Republic of Tanzania to other settings is not justified, but there are no indications of large geographical differences in the efficacy of zinc. It is therefore plausible that our findings are also applicable to other developing countries.

Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal

To investigate whether the finding in a previous study that homeopathic medicines decrease the duration of acute diarrhea in children could be replicated in a different study population. Randomized, double-blind, placebo-controlled trial. Private, charitable health clinic in Kathmandu, Nepal. A consecutive sample of 126 children, 6 months to 5 years of age, who presented during April through June, 1994, with more than three unformed stools in the previous 24 hours. Children received either an individualized homeopathic medicine or placebo, to be taken one dose after each unformed stool for 5 days. Parents recorded daily stools on diary cards, and health workers made home visits daily to monitor children. Predefined measures were based on the previous study: (1) duration of diarrhea, defined as the time until there were fewer than three unformed stools per day, for two consecutive days, and (2) Average number of stools per day for each group. Of the 126 children initially enrolled, 116 completed treatment. The mean number of stools per day over the entire 5-day treatment period was 3.2 for the treatment group and 4.5 for the placebo group (P = 0.023). A Kaplan-Meier survival analysis of the duration of diarrhea, which included data from all patient visits, showed an 18.4% greater probability that a child would be free of diarrhea by day 5 under homeopathic treatment (P = 0.036). These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration of diarrhea and number of stools in children with acute childhood diarrhea.

To the Editor

We are writing in response to the special article by Sampson and London critiquing our May 1994 publication, "Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua." We are pleased that Pediatrics provided an opportunity for further debate on this topic. However, we were surprised by the general tone and the number of statistical mis-statements and incorrect inferences in this critique. Because space has been limited in this rebuttal, we would like to limit our comments to a few key points: 1) misrepresentation of our claims, 2) methodological issues, and 3) the importance of open scientific discourse.

To the Editor

I am writing concerning Sampson and London's article, "Analysis of Homeopathic Treatment of Childhood Diarrhea" (Pediatrics November 1995) that critically reviewed the article by jacobs et al, "Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua" (Pediatrics May 1994). The primary problem with the criticisms that Sampson and London raise is that they have not thought through the implications of their arguments. Thus, plausible sounding objections that they offer often lead, upon careful scrutiny, to the opposite conclusion that the authors proclaim.

Treatment of Acute Childhood Diarrhea: A Review of the Literature

Acute childhood diarrhea and dehydration is a worldwide problem. Significant childhood morbidity and mortality resulting from associated dehydration exists in the United States as well. This paper is a review of the literature on the treatment and prevention of dehydration secondary to acute diarrhea episodes in children. Oral rehydration therapy (ORT), combined with homeopathic remedies, has shown to be the most effective treatment to date in the literature.

Analysis of Homeopathic Treatment of Childhood Diarrhea

The article entitled "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Dual in Nicaragua" by Jacobs et al (Pediatrics. 1994;93:719-725) reported a study of the efficacy of homeopathy in the treatment of acute childhood diarrhea. Children with diarrhea were entered into the study if the diarrhea was not severe (type C severe diarrhea patients were sent to a hospital). Oral rehydration therapy was begun, and subjects were randomly assigned to receive either homeopathic preparations or placebos. The preparations were determined by a computerized therapeutic scheme. This scheme depended on a family observer's answers to questions from an "experienced homeopathic practitioner." The article purports to show a statistically significant difference favoring the treatment group over the controls. The report has faults of 1) purpose, 2) method, 3) diagnosis and treatment selection, 4) results interpretation, and 5) authors' editorial comments. The reported difference between treatment and control groups are of dubious significance. This article argues that the study's conclusion that homeopathy is effective for childhood diarrhea is unwarranted. Homeopaths claim that homeopathy is an "alternative" medical system. The authors justify their research in the hope that homeopathy would have public health importance. If true, one would presume the system to be equal to or better than oral rehydration therapy. Therefore, even if it were positive, this study would not prove homeopathy to be an alternative to the standard treatment of childhood diarrhea. METHODS Government agencies do not routinely assay homeopathic products. Homeopathic products have been found to be adulterated with active material.1-3

Letter to the Editor

The article by Jacobs et al1 regarding treatment of acute childhood diarrhea with homeopathic medicine as an adjunct to the World Health Organization Oral Rehydration Solution (ORS) omits some essential measurements needed for comparison with previous literature reports and pertinent references from the last 15 years. The authors ignored the whole body of literature on rice- or cereal-based ORS (CB-ORS) that dealt with much larger patient samples and more precise measurements.2 These reports empha-sized the variability of results depending on the previous nutritional status of the child and whether adequate, nutritious diets were actually given the child on early refeeding.3