Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children

Abstract

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.

Editorial: Lactobacillus GG for diarrhoea in children—reports of its demise have been premature!

“…Dose (>10 10 vs <10 10 ), geographic location (European vs non‐European), aetiology (rotavirus or unknown vs invasive pathogen) and interval to initiation of treatment were important factors influencing outcome . Some of these observations are relevant to the interpretation of the two recent negative studies, which initiated probiotics in children who had been symptomatic for an average of 53 and 43 hours; later than is usually recommended . Indeed, both studies recruited children who had been symptomatic for up to 72 hours or more at the time of randomisation.…”

“…High‐quality RCTs remain central to progress in clinical medicine and are especially welcome in the probiotic literature; this systematic review reminds us that each new study needs to be critically reviewed in the context of what has preceded it, and with a keen eye cast over its particular details. For now the recommendation enshrined in guidelines stand – initiate probiotics alongside rehydration therapy early after the onset of presumed infectious diarrhoea in children …”

Management of Acute Gastroenteritis in Children: A Systematic Review of Anthroposophic Therapies

“…Although most cases are recorded in developing countries, such as Africa or Southeast Asia, acute gastroenteritis is also one of the most frequent reasons for death in developing countries [1,2]. In Europe, the incidence of diarrhea ranges from 0.5 to 2 episodes per child <3 years per year and is one of the third most common causes among hospital admission in Europe [1,3]. In Germany, 1 in 6 children is presented to a doctor once a year because of an acute gastroenteritis [4].…”

“…In 2016, 15 guidelines were available for the treatment of acute gastroenteritis. All of these guidelines postulate rehydration as a first-line treatment and dissuade administration of pharmaceutical medications such as antimotility drugs or antiemetics due to the unfavorable risk-benefit ratio [1]. The use of antibiotics should also only be considered under specific situations, namely in infections with Salmonella typhi , Vibrio cholerae , Entamoeba histolytica, and Giardia lamblia , or in children younger than 3 months, premature infants up to 52 weeks of post-conceptional age, children with immune defects, and children with suspected sepsis [1,5,6].…”

“…All of these guidelines postulate rehydration as a first-line treatment and dissuade administration of pharmaceutical medications such as antimotility drugs or antiemetics due to the unfavorable risk-benefit ratio [1]. The use of antibiotics should also only be considered under specific situations, namely in infections with Salmonella typhi , Vibrio cholerae , Entamoeba histolytica, and Giardia lamblia , or in children younger than 3 months, premature infants up to 52 weeks of post-conceptional age, children with immune defects, and children with suspected sepsis [1,5,6]. Interestingly, none of the guidelines explicitly mentioned complementary and alternative medicine (CAM) approaches although CAM and particularly anthroposophic therapies are being more and more used by pediatrics and became accepted methods for parents in the last decades [7,8,9].…”