7 December 2012

Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe (Medical students)

Salient point on the management of acute gastroenteritis (AGE) in children taken from ESPGHAN/ESPID guidelines for AGE management in European children.
  1. Reduced or hypotonic osmolarity ORS should be used as first-line therapy for the management of children AGE.
  2. When oral rehydration is not feasible, enteral rehydration by the nasogastric route is as effective if not better than IV rehydration.
  3. Probiotics may be an effective adjunct to the management of diarrhea. The following probiotics showed benefit in meta-analyses of RCTs: Lactobacillus and Saccharomyces boulardii.
  4. Loperamide should not be used in the management of AGE in children.
  5. Despite some clinical benefits for antiemetics (ondansetron and metoclopramide) it is suggested that they should not be routinely used to treat vomiting during AGE in children. Domperidone is not mentioned in the guidelines.
  6. The vast majority of young children with AGE can safely continue to receive lactose-containing milk formula because the number of treatment failures is negligible vs children with acute diarrhea on a lactose-free diet.
  7. Continue breast-feeding during acute gastroenteritis.
  8. Formula dilution and gradual reintroduction of feeding is not needed.
  9. Children who require rehydration should continue to be fed. Food should not be withdrawn for longer than 4 to 6 hours after the onset of rehydration.
  10. Anti-infective therapy should not be given to the vast majority of otherwise healthy children with acute gastroenteritis.
  11. Antibiotic therapy for acute bacterial gastroenteritis is not needed routinely, but only for specific pathogens or in defined clinical settings.
European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases (ESPGHAN, 2008). Read Full Text online