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Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children
Andrea Lo Vecchio1, Jorge Amil Dias, James A Berkley
1*Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy †Departamento de Pediatria Médica, Hospital de São João, Porto, Portugal ‡KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya §Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ||Department of Pediatrics, University of Alabama at Birmingham, Birmingham ¶INTA, Universidad de Chile, Macul, Chile #Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru **Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom ††Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada ‡‡Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Insights
Clinical practice guidelines for acute gastroenteritis (AGE) in children show similar core recommendations for management. This systematic review provides a foundation for developing universal AGE treatment guidelines globally.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute gastroenteritis (AGE) is a significant global health concern, contributing substantially to child mortality and morbidity.
- Existing clinical practice guidelines (CPGs) for AGE management vary, necessitating a review to identify commonalities and discrepancies.
Purpose of the Study:
- To systematically review and compare recommendations across existing CPGs for childhood AGE.
- To establish a basis for developing unified, universal guidelines for managing AGE in children worldwide.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Cochrane-Library) and relevant organizational websites.
- Fifteen clinical practice guidelines (CPGs) for acute gastroenteritis in children were identified and analyzed for their recommendations.
Main Results:
- Definitions of AGE varied, but key management principles showed consistency across CPGs.
- Oral rehydration solution is universally recommended; hypo-osmolar or low-osmolality solutions are preferred.
- Early refeeding is strongly advised, while routine antibiotic use and antiemetics are generally discouraged. Zinc supplementation is recommended in many guidelines, particularly from low-income countries.
Conclusions:
- Despite variations in definitions, core recommendations for managing childhood AGE are largely consistent among reviewed CPGs.
- These consistent findings offer a strong foundation for developing evidence-based, universal guidelines for AGE management in children globally.
Objective:
Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines.
Methods:
CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs.
Results:
The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na 45-60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged.
Conclusions:
Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.
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