Polymer-based oral rehydration solution for treating acute watery diarrhoea

Area of Science:

• Pediatrics
• Infectious Diseases
• Gastroenterology
• Public Health

Background:

• Acute diarrhoea is a leading cause of child morbidity and mortality globally, particularly in low-income settings.
• Glucose-based oral rehydration solution (ORS) is a standard treatment for fluid and electrolyte replacement.
• The World Health Organization (WHO) recommends specific osmolarity standards for ORS formulations.

Purpose of the Study:

• To compare the efficacy of polymer-based ORS versus traditional glucose-based ORS in treating acute watery diarrhoea.
• To evaluate outcomes such as stool output, duration of diarrhoea, and need for intravenous fluid replacement.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases including Cochrane, MEDLINE, EMBASE, and LILACS up to September 2016.
• Included 35 RCTs with 4284 participants (predominantly children) comparing polymer-based ORS with glucose-based ORS.

Main Results:

• Polymer-based ORS demonstrated a reduction in mean stool output (24 mL/kg in 24 hours) and diarrhoea duration (8 hours) compared to glucose-based ORS (≤ 270 mOsm/L), though evidence quality was low and heterogeneous.
• Compared to glucose-based ORS (≥ 310 mOsm/L), polymer-based ORS significantly reduced total stool output (65 mL/kg in 24 hours) and diarrhoea duration (8 hours), with low-quality evidence and substantial heterogeneity.
• Fewer participants receiving polymer-based ORS required unscheduled intravenous fluid, particularly in cases of mixed pathogen infections.

Conclusions:

• Polymer-based ORS shows significant advantages over standard glucose-based ORS, especially formulations with higher osmolarity (≥ 310 mOsm/L).
• While comparisons with lower osmolarity ORS (≤ 270 mOsm/L) favoured polymer-based solutions, the analysis was limited by sample size.
• Polymer-based ORS represents a promising alternative for managing acute watery diarrhoea, potentially improving treatment outcomes.