European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence‐based Guidelines for the Management of Acute Gastroenteritis in Children in Europe

Abstract

Guidelines Development GroupThis project was strictly based on a thorough analysis of the evidence available, its evaluation, and the grading of statements and recommendations with specific instruments. The guidelines were developed by an ESPGHAN/ ESPID Working Group that comprised 7 experts from France, The Netherlands, Israel, Italy, and Poland, coordinated by Alfredo Guarino. The experts are pediatricians with a special interest in gastroenterology and in infectious diseases. The work was undertaken as a collaborative research project: each working group member was in charge of systematically searching the literature, producing tables of evidence, and drafting the text. Specifically, the Naples group (A. Guarino, F. Albano, A. Lo Vecchio) was in charge of the definition, epidemiology, risk factors, and indications for a medical visit and hospital admission; Hans Hoekstra handled the clinical evaluation and disease severity section; Raanan Shamir and Corina Hartman focused on diagnostic workup and nutritional management; the Warsaw group (A. Chmielewska, B. Patro, M. Ruszczyn ´ski) under the leadership of Hania Szajewska dealt with the methodological section, rehydration, and pharmacological therapy. Finally, the ESPID representatives (S. Ashkenazi and his collaborators L. Hoffnung and N. Tirosh, and D. Gendrel) were in charge of the anti-infective therapy and the prevention sections. The recommendations were formulated collectively, and the final draft was collated and harmonized in Naples, and was agreed upon by the entire working group. The final draft underwent external review and was approved by the ESPGHAN and ESPID councils. S82GUARINO ET AL.

Anti-Infective Activities of Lactobacillus Strains in the Human Intestinal Microbiota: from Probiotics to Gastrointestinal Anti-Infectious Biotherapeutic Agents

“…Human probiotic Lactobacillus strains and drugs derived from several of these strains have been clinically investigated to treat acute infectious diarrhea (Table 3). In RCTs investigating their therapeutic efficacy, they have been generally used in association with ORS (293). In RTCs, L. rhamnosus GG alone or in combination with ORS has demonstrated therapeutic efficacy in significantly reducing by at least half the duration of acute diarrhea mainly resulting from rotavirus infection in children (296)(297)(298)(299)(300)(301)(302)(303)(304)(305)(306)(307)(308)(309)(310).…”

“…Such treatment is intended to prevent the dehydration and nutritional damage and to reduce the length and severity of acute diarrhea. To prevent dehydration and nutritional damage in children and infants with acute diarrhea, the therapeutic regimen recommended by the WHO, the European Society for Pediatric Infectious Diseases (ESPID), and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) is to provide an oral rehydration solution (ORS) and to continue feeding (293). Although ORS administration effectively mitigates dehydration, it has no effect on the length and severity of diarrheal episodes.…”

Rotavirus Infection in Children is an Unsolved Problem. Review of Guidelines for Vaccinal Prevention

“…Среди них наиболь-ший удельный вес приходится на Rotavirus и в меньшей степени на Norovirus (англ. Norwalk Virus), тогда как Campylobacter и Salmonella -основные бактериальные агенты -серьезно уступают [5,6].…”

Diagnostic Value of Determining the Level of Procalcitonin in the Practice of an Infectious Disease Specialist

“…На практике, основываясь только на клиниче-ской симптоматике и микроскопии кала, дифференциро-вать бактериальные и вирусные гастроэнтериты удается не всегда. Тем более что с учетом значительно более высокой частоты вирусных форм заболевания, высокой стоимости, длительности выполнения, а также невозмож-ности выделить бактерионосителей с вирусным гастро-энтеритом рутинное бактериологическое исследование кала не рекомендуется [35]. Таким образом, необходимы более значимые предикторы для выделения тех форм острых гастроэнтеритов, которые требуют назначения системного антибиотика.…”