Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis
What this study found
Probiotics did not show a reliable clinical benefit and are not supported for routine use in developed-country pediatric gastroenteritis. In pooled analyses, hospitalization within 7 days was not significantly reduced (RR 0.53, 95% CI 0.26, 1.07), intravenous rehydration within 7 days was not reduced (RR 1.13, 95% CI 0.81, 1.57), and return to the emergency department within 7 days was not reduced (RR 0.78, 95% CI 0.36, 1.67). Most probiotic comparisons were single-trial analyses, and the evidence base was low quality. By contrast, the broader review found better support for antiemetics and…
- Study & population
- Systematic review and meta-analysis of children under 18 years with gastroenteritis in developed countries, mainly in outpatient or emergency department settings.
- Intervention
- Probiotic products were evaluated as adjunctive therapy for pediatric gastroenteritis in outpatient and emergency department settings, generally compared with placebo.
- Key limitation
- The probiotic evidence was limited, low quality, and often based on single trials, which reduces confidence in the estimates.
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Open PDFOriginal abstract
Context Gastroenteritis remains a leading cause of childhood morbidity. Objective Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected. Data Sources MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings. Study Selection Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate. Data Extraction The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models. Results 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92). Conclusions There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge.