Management of acute diarrhoea

Italian Journal of Pediatrics 2017, 43(Suppl 1): A2

Diarrhoea in children still has a major impact on health-related social costs, affecting approximately 2 billion children younger than 5 years every year, and determining 2 million deaths, mostly in Africa and Asia. [1] According to WHO diarrhea consists in ≥3 passages of softened or liquid stools within 24 hours. Acute forms (duration 0-7 days) are traditionally defined in distinction with protracted (7-14 days) and chronic (>14 days) diarrhoea. ESPGHAN guidelines [2] state that acute gastroenteritis (AGE) does not generally require a specific diagnostic work-up. Microbiologic investigations should be limited to subjects with chronic diseases, in severely compromised conditions or with long-lasting symptoms that could be potentially eligible for specific treatments. The assessment of the degree of dehydration still remains the cornerstone of the management. Newborns and children aged less than 2 months, subjects with severe conditions, persistent vomit or massive diarrhea (>8 episodes/day) should be always clinically assessed. Hospital admission should be considered in cases of shock, severe dehydration, neurological abnormalities, intractable or bilious vomit, oral rehydration failure, when a surgical condition is suspected or when parental management at home does not represent a safe option. The distinction between bacterial and non-bacterial etiologies is not relevant to the treatment: the basic therapy is oral rehydration [3]. Sometimes oral rehydration is not sufficient and i.v. fluids may be required (shock, altered level of consciousness, severe acidosis, failure of oral/enteral rehydration, persistent vomit, abdominal distension or ileus). In children, AGE treatment may include the use of several drugs (antiemetics, probiotics, anti-secretory drugs, gelatin tannate). Antiemetics decrease need for hospitalization, but may entail electrocardiographic alterations (i.e. prolonged QT interval) [2]. A recent Cochrane review [4] concluded that probiotics may have a role in decreasing duration of diarrhoea of approximately one day, in reducing stool frequency during the second day and the risk of diarrhea lasting longer than 4 days. Even though some “strong recommendations” support the use of some specific strains (Lactobacillus GG and Saccharomyces boulardii), quality of evidence in favour of probiotics is generally low [4, 5]. Data regarding diosmectite and racecadotril should be carefully interpreted, as most of the available studies present major drawbacks [6, 7]. Finally, some evidence supports the use of gelatin tannate, a “mucosal regenerator” that creates a layer adhering to the intestinal wall which can protect against the penetration of aggressive bacteria [8, 9].