Clinical practice guidelines for acute infectious diarrhea in children in China (2024)
You-Hong Fang1, Chao-Min Wan2, Si-Tang Gong3
1Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China.
Insights
Updated guidelines offer evidence-based strategies for pediatric acute infectious diarrhea. Key updates include refined etiological diagnosis and recommendations for probiotics, zinc, and judicious antibiotic use in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Significant advancements in diagnosing and treating pediatric acute infectious diarrhea have emerged since the 2018 guidelines.
- The updated guidelines incorporate new evidence-based recommendations tailored for the Chinese pediatric population.
Purpose of the Study:
- To present revised clinical practice guidelines for acute infectious diarrhea in children.
- To integrate the latest scientific evidence and expert consensus into pediatric diarrhea management.
Main Methods:
- Expert panels reviewed clinical evidence and conducted discussions based on the 2018 guidelines.
- A comprehensive literature search was performed across major databases up to June 2024.
- Keywords included "acute diarrhea" or "enteritis" combined with pediatric age groups.
Main Results:
- The updated guidelines cover diagnosis, etiology, dehydration assessment, fluid and diet therapy, and prevention.
- Key revisions focus on etiological diagnosis, and the application of probiotics, racecadotril, zinc, and antibiotics.
Conclusions:
- Revised guidelines address controversial treatments using evidence-based approaches.
- Standardized etiological evaluations are recommended for guiding management.
- Probiotics are suggested for viral watery diarrhea; zinc is recommended for children over 6 months in deficient areas; antibiotics are reserved for specific severe or complicated cases.
Background:
Some new progress and evidence have been made in the diagnosis and treatment of pediatric acute infectious diarrhea since the publication of the "Chinese clinical practice guidelines for acute infectious diarrhea in children" (2018 edition guidelines). The updated "Chinese clinical practice guidelines for acute infectious diarrhea in children" incorporates new evidence-based recommendations for managing acute infectious diarrhea in the Chinese pediatric population.
Data Sources:
Building on the 2018 edition guidelines, expert panels reviewed clinical evidence, assessed preliminary recommendations, and conducted open-ended discussions to finalize the updated guidelines. These guidelines are founded on the latest literature and evidence-based practices. A literature review was performed in databases such as PubMed, Cochrane, EMBASE, China Biomedical Database, and the Chinese Journal Full-text Database up to June 2024. The search focused on the terms "acute diarrhea" or "enteritis", along with "adolescent", "child", "pediatric patient", "baby", or "infant".
Results:
The updated guidelines address various aspects of acute infectious diarrhea, including diagnosis, etiological evaluation, dehydration assessment, fluid therapy, diet therapy, medical therapy, and prevention strategies. The main updates focused on etiological diagnosis and the use of probiotics, racecadotril, zinc, and antibiotics in treating acute infectious diarrhea.
Conclusions:
The updated guidelines address disputed treatments for acute infectious diarrhea through evidence-based revisions. Standardized etiological evaluations guide management. Probiotics are moderately advised for viral watery diarrhea; racecadotril remains unsupported. Zinc supplementation is recommended for children >6 months in deficient regions. Antibiotics are restricted to cases with dysenteric-like symptoms, suspected cholera with severe dehydration, or comorbidities.
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