Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trialsReport as inadecuate




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BMC Medicine

, 2:11

First Online: 15 April 2004Received: 29 September 2003Accepted: 15 April 2004DOI: 10.1186-1741-7015-2-11

Cite this article as: Bellemare, S., Hartling, L., Wiebe, N. et al. BMC Med 2004 2: 11. doi:10.1186-1741-7015-2-11

Abstract

BackgroundDespite treatment recommendations from various organizations, oral rehydration therapy ORT continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials RCTs to compare ORT and intravenous therapy IVT for the treatment of dehydration secondary to acute gastroenteritis in children.

MethodsRCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques.

ResultsThe quality of the 14 included trials ranged from 0 to 3 Jadad score; allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures risk difference RD 3%; 95% confidence intervals CI: 0, 6. The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups RD 4%; 95% CI: 2, 5 favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo-hypernatremia. Length of stay was significantly shorter for the ORT group weighted mean difference WMD -1.2 days; 95% CI: -2.4,-0.02. Phlebitis occurred significantly more often with IVT number needed to treat NNT 33; 95% CI: 25,100; paralytic ileus occurred more often with ORT NNT 33; 95% CI: 20,100. These results may not be generalizable to children with persistent vomiting.

ConclusionThere were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children 95% CI: 20, 50 treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis.

Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-2-11 contains supplementary material, which is available to authorized users.





Author: Steven Bellemare - Lisa Hartling - Natasha Wiebe - Kelly Russell - William R Craig - Don McConnell - Terry P Klassen

Source: https://link.springer.com/



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