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Résumé: Contexte: La recommandation de l’OMS et l’UNICEF d’utiliser le soluté de réhydratation orale (SRO) et les mesures diététiques pour traiter la diarrhée aiguë ne semble pas être appliquée par de nombreux personnels de santé en Afrique sub-saharienne d’où une morbi-mortalité infanto-juvéniles élevées. Objectif: Décrire les habitudes de prescription du personnel de santé lors de la diarrhée aiguë de l’enfant à Abidjan. Patients et méthodes: Étude transversale réalisée dans 52 structures sanitaires publiques non spécialisées d’Abidjan du 1er juin au 31 juillet 2012. Elle a porté sur les habitudes de prescription de 151 personnels de santé consentants prenant en charge des enfants. Résultats: Ce sont 100 médecins (pédiatre 18, DES en pédiatrie 28, généralistes 54) et 51 soignants qui ont été interviewés. L’âge moyen était de 39ans (25–59ans) ; la moyenne d’année d’exercice de 8,4 années (1–35ans). Les enquêtés affirmaient prescrire de façon systématique le SRO (53 %) et les mesures diététiques (28,5 %). Ils affirmaient conseiller la poursuite du lait maternel 97,4 %, le lait de régime 43 % et le régime alimentaire anti-diarrhéique 24,5 %. Les médecins prescrivaient plus le SRO et le régime alimentaire anti-diarrhéique par rapport au personnel soignant (32,8 vs 16,9 %, p <0,05) ; alors que la prescription des mesures diététiques simples était davantage le fait du personnel soignant (80,4 vs 58,1 %, p <0,005). Les enquêtés affirmaient prescrire des antibiotiques et des mesures adjuvantes respectivement dans 76,8 % et 97 %. Conclusion: Les habitudes de prescription du personnel de santé s’éloignent des recommandations de l’OMS et de l’UNICEF. La sensibilisation du personnel sur les directives de prise en charge de la diarrhée aiguë s’avère nécessaire pour l’amélioration du pronostic de cette affection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Racecadotril is an antidiarrhoeal drug with intestinal antisecretory mechanism of action. Aim: To assess racecadotril efficacy as an adjunct to oral rehydration solution, against oral rehydration solution alone or with placebo in childhood acute gastroenteritis. Methods: Individual patient data meta-analysis following multilevel mixed models testing the significance of the treatment effect adjusted for baseline covariates. Results: Nine randomised clinical trials (n =1384) were identified with raw data. Baseline dehydration level and Rotavirus were found as two essential predictors influencing the outcomes. The proportion of recovered patients was higher in racecadotril groups compared with placebo, Hazard Ratio HR=2.04, 95% CI (1.85; 2.32), p <0.001. For inpatient studies, the ratio of mean stool output racecadotril/placebo was 0.59 (0.51; 0.74), p <0.001. For outpatient studies, the ratio of the mean number of diarrhoeic stools racecadotril/placebo was 0.63 (0.51; 0.74), p <0.001. Conclusion: Dehydration level and Rotavirus at baseline are essential adjustments to compare treatments. As an adjunct to oral rehydration solution, racecadotril has a clinically relevant effect in reducing diarrhoea (duration, stool output and stool number), irrespective of baseline conditions (dehydration, Rotavirus or age), treatment conditions (inpatient or outpatient studies) or cultural environment. [Copyright &y& Elsevier]

Abstract: Background: Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain. Objective: To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis. Discussion: The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Studies are conflicting on whether blood urea nitrogen (BUN) or BUN/creatinine ratio correlates with dehydration, but several studies found that low serum bicarbonate combined with certain clinical parameters predicts dehydration. In most studies, oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous (i.v.) rehydration. Many experts discourage the routine use of antiemetics in young children. However, children receiving ondensetron are less likely to vomit, have greater oral intake, and are less likely to be treated by intravenous rehydration. Mean length of Emergency Department (ED) stay is also less, and very few serious side effects have been reported. Conclusions: In the ED, dehydration is evaluated by synthesizing the historical and physical examination, and obtaining laboratory data points in select patients. No single laboratory value has been found to be accurate in predicting the degree of dehydration and this is not routinely recommended. The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy. Ondansetron (orally or intravenously) may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration. [Copyright &y& Elsevier]

La diarrhée aiguë est toujours potentiellement grave chez l’enfant, mais les variations des tableaux cliniques sont importantes. De nombreuses recommandations existent, mais on ne peut définir des indications thérapeutiques applicables à tous les cas. L’analyse clinique et l’évaluation de la déshydratation sont cruciales. Les solutions de réhydratation par voie orale sont d’utilisation systématique chez le jeune enfant. Le traitement antibiotique est réservé à certaines étiologies. Les médicaments antidiarrhéiques sont utiles, toujours en complément de la réhydratation par voie orale. La réalimentation précoce est systématique. Le processus diarrhéique peut durer quelques jours, comme par exemple lors d’une infection à rotavirus, cause la plus fréquente des diarrhées. Toute persistance exagérée doit faire rechercher un risque de passage à la chronicité, source de dénutrition qu’il faut savoir prévenir. [Copyright &y& Elsevier]

Abstract: Although previous studies have shown successful treatment of persistent diarrhea (PD) with the use of yogurt-based diets, some recent ones speculate the need of special formulas for the nutritional management of PD complicated cases. In the present study, we tested the hypothesis that the consumption of 3 lactose-free diets, with different degrees of complexity, is associated with lower stool output and shorter duration of diarrhea when compared with the use of a yogurt-based one on the nutritional management of PD. A total of 154 male infants, aged between 1 and 30 months, with PD and with or without dehydration, were randomly assigned to 1 of 4 treatment groups. Throughout the study, the patients were placed in a metabolic unit; their body weights and intakes of oral rehydration solution, water, and formula diets, in addition to outputs of stool, urine, and vomit, were measured and recorded at 24-hour intervals. Four different diets were used in this study: diet 1, yogurt-based formula; diet 2, soy-based formula; diet 3, hydrolyzed protein-based formula; and diet 4, amino acid–based formula. Throughout the study, only these formula diets were fed to the children. The data showed that children fed the yogurt-based diet (diet 1) or the amino acid–based diet (diet 4) had a significant reduction in stool output and in the duration of diarrhea. The use of an inexpensive and worldwide-available yogurt-based diet is recommended as the first choice for the nutritional management of mild to moderate PD. For the few complicated PD cases, when available, a more complex amino acid–based diet should be reserved for the nutritional management of these unresponsive and severe presentations. Soy-based or casein-based diets do not offer any specific advantage or benefits and do not seem to have a place in the management of PD. [Copyright &y& Elsevier]

Abstract: The prognosis of acute diarrhoea in infants is most often satisfactory in industrialized countries. However, it has been estimated that 10 to 15 children die every year in France from acute dehydration due to acute diarrhoea. In spite of an increasing use over the least few years, oral rehydration solutions (ORS) are used in only 70% of infants presenting with acute diarrhoea. The use of homemade ORS, plain water or fizzy drink should be strictly avoided. In case of acute diarrhoea there is no indication to stop breastfeeding or the use of infant formula for more than 4 hours. Lactose intolerance is observed in only 5–10% of infants. Lactose free formulae should only be used in infants with severe, persistent or recurrent diarrhoea. Under 3–4 months of age, infants with severe diarrhoea should receive for a period of 2–4 weeks lactose free protein hydrolysate formulae. Racecadotril is the only drug with anti-diarrheal properties, with a reduction of the stool output of 50%. Oral antibiotics should only be used in case of Shigella infection or in case of bacterial infection with severe sepsis or underlying debilitating disease. Oral Rotavirus vaccine, that is not reimbursed yet in France, has been shown to dramatically reduce the number of severe cases of diarrhoea with dehydration, and has been associated with a striking reduction of both morbidity and mortality, as well as of the number of hospitalisations during periods of epidemics. [Copyright &y& Elsevier]

This paper written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie is specially devoted to the nutritional treatment of infant and child acute diarrhea, ie oral rehydration with salts solution and feeding. It complements an article on drug therapy of child acute diarrhea written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, and published in this same issue of the Archives de pe´diatrie. [ABSTRACT FROM AUTHOR]

Background: Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea. Objective:We sought to measure the effect of supplemental zinc given with oral rehydration therapy during recovery from acute or persistent diarrhea. Design: We conducted pooled analyses including all available published and unpublished randomized controlled trials of the effects of supplementary oral zinc in children aged <5 y with acute or persistent diarrhea. We used Cox survival regression analysis to evaluate the overall effect of zinc on continuation of diarrhea and possible differential effects in subgroups divided by sex, age, weight-for-height, and initial plasma zinc concentration. Dichotomous outcomes were analyzed by logistic regression. To assess the effects of excluding studies without original data from the pooled analyses, effect-size was estimated for all studies by using random-effects models. Results: Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given day (95% CI: 5%, 24%) in the acute-diarrhea trials and a 24% lower probability of continuing diarrhea (95% CI: 9%, 37%) and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the persistent-diarrhea trials. In none of the subgroup analyses were the 2 subgroups of each pair significantly different from each other; however, in persistent diarrhea there tended to be a greater effect in subjects aged <12 mo, who were male, or who had wasting or lower baseline plasma zinc concentrations. Conclusion: Zinc supplementation reduces the duration and severity of acute and persistent diarrhea. [ABSTRACT FROM AUTHOR]

Reports on the use of rice-electrolyte oral rehydration solution (ORS) for the treatment of diarrhea in children. Preparation of the solution; Composition of the World Health Organization glucose-based ORS.

Abstract: Acute infectious diarrhea in children remain still a frequent cause of morbidity. 50 % of them are due to rotavirus. Oral rehydratation therapy and early realimentation have drastically reduced their mortality and morbidity. Beside oral or eventually IV rehydratation therapy no medication has proven its efficacy based on the main HMO criteria (reduction of over 30 % of the stool output) except racecadotril and loperamide which is contre-indicated for the last one in children less than 2 years old. Other medications such as silicates or some probiotics have shown efficacy on diarrhea duration or stool consistancy but not on stool output. They have so no formal indication in infectious diarrhea and should be considered as "comfort" treatment. Antibiotics, beside their indication in shigella, cholera and amibiasis could be used in invasive diarrhea in some debilating conditions or infants less than 3 months. [Copyright &y& Elsevier]

Presents abstracts of the articles entitled `Efficacy of glucose-based oral rehydration therapy,' by N. Gavin, N. Merrick et al and `Weight modification efforts reported by black and white preadolescent girls: National Heart, Lung and Blood Institute Growth and Health Study,' by G.B. Scheiber, M. Robins et al published in the July 1996 issue of `Pediatrics' periodical.