Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1998 Sep;79(3):279–284. doi: 10.1136/adc.79.3.279

Guidelines for managing acute gastroenteritis based on a systematic review of published research

M Murphy 1
PMCID: PMC1717684  PMID: 9875030

Full Text

The Full Text of this article is available as a PDF (108.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdalla S., Helmy N., el Essaily M., Nasser S., Hirschhorn Oral rehydration for the low-birthweight baby with diarrhoea. Lancet. 1984 Oct 6;2(8406):818–819. doi: 10.1016/s0140-6736(84)90749-9. [DOI] [PubMed] [Google Scholar]
  2. Antibiotic antagonism and synergy. Lancet. 1978 Jul 8;2(8080):80–82. [PubMed] [Google Scholar]
  3. Baraff L. J. Capillary refill: is it a useful clinical sign? Pediatrics. 1993 Nov;92(5):723–724. [PubMed] [Google Scholar]
  4. Bergström T., Alestig K., Thorén K., Trollfors B. Symptomatic treatment of acute infectious diarrhoea: loperamide versus placebo in a double-blind trial. J Infect. 1986 Jan;12(1):35–38. doi: 10.1016/s0163-4453(86)94833-4. [DOI] [PubMed] [Google Scholar]
  5. Bhan M. K., Mahalanabis D., Fontaine O., Pierce N. F. Clinical trials of improved oral rehydration salt formulations: a review. Bull World Health Organ. 1994;72(6):945–955. [PMC free article] [PubMed] [Google Scholar]
  6. Bhargava S. K., Sachdev H. P., Das Gupta B., Daral T. S., Singh H. P., Mohan M. Oral rehydration of neonates and young infants with dehydrating diarrhea: comparison of low and standard sodium content in oral rehydration solutions. J Pediatr Gastroenterol Nutr. 1984 Sep;3(4):500–505. doi: 10.1097/00005176-198409000-00004. [DOI] [PubMed] [Google Scholar]
  7. Bhattacharya S. K., Bhattacharya M. K., Manna B., Dutta D., Deb A., Dutta P., Goswami A. G., Dutta A., Sarkar S., Mukhopadhaya A. Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study. Acta Paediatr. 1995 Feb;84(2):160–164. doi: 10.1111/j.1651-2227.1995.tb13602.x. [DOI] [PubMed] [Google Scholar]
  8. Brown K. H., Gastañaduy A. S., Saavedra J. M., Lembcke J., Rivas D., Robertson A. D., Yolken R., Sack R. B. Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr. 1988 Feb;112(2):191–200. doi: 10.1016/s0022-3476(88)80055-6. [DOI] [PubMed] [Google Scholar]
  9. Brown K. H., Peerson J. M., Fontaine O. Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials. Pediatrics. 1994 Jan;93(1):17–27. [PubMed] [Google Scholar]
  10. Du Pont H. L. Nonfluid therapy and selected chemoprophylaxis of acute diarrhea. Am J Med. 1985 Jun 28;78(6B):81–90. doi: 10.1016/0002-9343(85)90369-9. [DOI] [PubMed] [Google Scholar]
  11. Dugdale A., Lovell S., Gibbs V., Ball D. Refeeding after acute gastroenteritis: a controlled study. Arch Dis Child. 1982 Jan;57(1):76–78. [PMC free article] [PubMed] [Google Scholar]
  12. Duggan C., Refat M., Hashem M., Wolff M., Fayad I., Santosham M. How valid are clinical signs of dehydration in infants? J Pediatr Gastroenterol Nutr. 1996 Jan;22(1):56–61. doi: 10.1097/00005176-199601000-00009. [DOI] [PubMed] [Google Scholar]
  13. Eccles M., Clapp Z., Grimshaw J., Adams P. C., Higgins B., Purves I., Russell I. North of England evidence based guidelines development project: methods of guideline development. BMJ. 1996 Mar 23;312(7033):760–762. doi: 10.1136/bmj.312.7033.760. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Faruque A. S., Mahalanabis D., Islam A., Hoque S. S., Hasnat A. Breast feeding and oral rehydration at home during diarrhoea to prevent dehydration. Arch Dis Child. 1992 Aug;67(8):1027–1029. doi: 10.1136/adc.67.8.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Faruque A. S., Mahalanabis D., Islam A., Hoque S. S., Hasnat A. Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control study. Am J Trop Med Hyg. 1993 Jul;49(1):93–100. doi: 10.4269/ajtmh.1993.49.93. [DOI] [PubMed] [Google Scholar]
  16. Fuchs S. C., Victora C. G., Martines J. Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning. BMJ. 1996 Aug 17;313(7054):391–394. doi: 10.1136/bmj.313.7054.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Goepp J. G., Katz S. A. Oral rehydration therapy. Am Fam Physician. 1993 Mar;47(4):843–851. [PubMed] [Google Scholar]
  18. Goodburn E., Mattosinho S., Mongi P., Waterston T. Management of childhood diarrhoea by pharmacists and parents: is Britain lagging behind the Third World? BMJ. 1991 Feb 23;302(6774):440–443. doi: 10.1136/bmj.302.6774.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Gore S. M., Fontaine O., Pierce N. F. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ. 1992 Feb 1;304(6822):287–291. doi: 10.1136/bmj.304.6822.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gorelick M. H., Shaw K. N., Baker M. D. Effect of ambient temperature on capillary refill in healthy children. Pediatrics. 1993 Nov;92(5):699–702. [PubMed] [Google Scholar]
  21. Hirschhorn N., Kinzie J. L., Sachar D. B., Northrup R. S., Taylor J. O., Ahmad S. Z., Phillips R. A. Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions. N Engl J Med. 1968 Jul 25;279(4):176–181. doi: 10.1056/NEJM196807252790402. [DOI] [PubMed] [Google Scholar]
  22. Hoghton M. A., Mittal N. K., Sandhu B. K., Mahdi G. Effects of immediate modified feeding on infantile gastroenteritis. Br J Gen Pract. 1996 Mar;46(404):173–175. [PMC free article] [PubMed] [Google Scholar]
  23. Isolauri E., Juntunen M., Wiren S., Vuorinen P., Koivula T. Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management. J Pediatr Gastroenterol Nutr. 1989 May;8(4):466–473. doi: 10.1097/00005176-198905000-00008. [DOI] [PubMed] [Google Scholar]
  24. Isolauri E., Vesikari T., Saha P., Viander M. Milk versus no milk in rapid refeeding after acute gastroenteritis. J Pediatr Gastroenterol Nutr. 1986 Mar-Apr;5(2):254–261. [PubMed] [Google Scholar]
  25. Isolauri E., Vesikari T., Saha P., Viander M. Milk versus no milk in rapid refeeding after acute gastroenteritis. J Pediatr Gastroenterol Nutr. 1986 Mar-Apr;5(2):254–261. [PubMed] [Google Scholar]
  26. Khin M. U., Nyunt-Nyunt-Wai, Myo-Khin, Mu-Mu-Khin, Tin U., Thane-Toe Effect on clinical outcome of breast feeding during acute diarrhoea. Br Med J (Clin Res Ed) 1985 Feb 23;290(6468):587–589. doi: 10.1136/bmj.290.6468.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lulseged S. Predictors of moderate to severe dehydration in acute diarrhoeal disease: a case-control study. Ethiop Med J. 1992 Apr;30(2):69–78. [PubMed] [Google Scholar]
  28. Mandal B. K., Ellis M. E., Dunbar E. M., Whale K. Double-blind placebo-controlled trial of erythromycin in the treatment of clinical campylobacter infection. J Antimicrob Chemother. 1984 Jun;13(6):619–623. doi: 10.1093/jac/13.6.619. [DOI] [PubMed] [Google Scholar]
  29. Meyers A. Fluid and electrolyte therapy for children. Curr Opin Pediatr. 1994 Jun;6(3):303–309. doi: 10.1097/00008480-199406000-00012. [DOI] [PubMed] [Google Scholar]
  30. Nalin D. R., Harland E., Ramlal A., Swaby D., McDonald J., Gangarosa R., Levine M., Akierman A., Antoine M., Mackenzie K. Comparison of low and high sodium and potassium content in oral rehydration solutions. J Pediatr. 1980 Nov;97(5):848–853. doi: 10.1016/s0022-3476(80)80287-3. [DOI] [PubMed] [Google Scholar]
  31. Nalin D. R., Levine M. M., Mata L., de Céspedes C., Vargas W., Lizano C., Loria A. R., Simhon A., Mohs E. Oral rehydration and maintenance of children with rotavirus and bacterial diarrhoeas. Bull World Health Organ. 1979;57(3):453–459. [PMC free article] [PubMed] [Google Scholar]
  32. Nelson J. D., Kusmiesz H., Jackson L. H., Woodman E. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics. 1980 Jun;65(6):1125–1130. [PubMed] [Google Scholar]
  33. Newton T., Murphy M. S., Booth I. W. Glucose polymer as a cause of protracted diarrhea in infants with unsuspected congenital sucrase-isomaltase deficiency. J Pediatr. 1996 Jun;128(6):753–756. doi: 10.1016/s0022-3476(96)70325-6. [DOI] [PubMed] [Google Scholar]
  34. PHILLIPS R. A. WATER AND ELECTROLYTE LOSSES IN CHOLERA. Fed Proc. 1964 May-Jun;23:705–712. [PubMed] [Google Scholar]
  35. Pai C. H., Gillis F., Tuomanen E., Marks M. I. Placebo-controlled double-blind evaluation of trimethoprim-sulfamethoxazole treatment of Yersinia enterocolitica gastroenteritis. J Pediatr. 1984 Feb;104(2):308–311. doi: 10.1016/s0022-3476(84)81020-3. [DOI] [PubMed] [Google Scholar]
  36. Penny M. E., Paredes P., Brown K. H. Clinical and nutritional consequences of lactose feeding during persistent postenteritis diarrhea. Pediatrics. 1989 Nov;84(5):835–844. [PubMed] [Google Scholar]
  37. Pizarro D., Posada G., Levine M. M. Hypernatremic diarrheal dehydration treated with "slow" (12-hour) oral rehydration therapy: a preliminary report. J Pediatr. 1984 Feb;104(2):316–319. doi: 10.1016/s0022-3476(84)81023-9. [DOI] [PubMed] [Google Scholar]
  38. Pizarro D., Posada G., Villavicencio N., Mohs E., Levine M. M. Oral rehydration in hypernatremic and hyponatremic diarrheal dehydration. Am J Dis Child. 1983 Aug;137(8):730–734. doi: 10.1001/archpedi.1983.02140340014003. [DOI] [PubMed] [Google Scholar]
  39. Placzek M., Walker-Smith J. A. Comparison of two feeding regimens following acute gastroenteritis in infancy. J Pediatr Gastroenterol Nutr. 1984 Mar;3(2):245–248. doi: 10.1097/00005176-198403000-00014. [DOI] [PubMed] [Google Scholar]
  40. Portnoy B. L., DuPont H. L., Pruitt D., Abdo J. A., Rodriguez J. T. Antidiarrheal agents in the treatment of acute diarrhea in children. JAMA. 1976 Aug 16;236(7):844–846. [PubMed] [Google Scholar]
  41. Recommendations for composition of oral rehydration solutions for the children of Europe. Report of an ESPGAN Working Group. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):113–115. [PubMed] [Google Scholar]
  42. Rees L., Brook C. G. Gradual reintroduction of full-strength milk after acute gastroenteritis in children. Lancet. 1979 Apr 7;1(8119):770–771. doi: 10.1016/s0140-6736(79)91220-0. [DOI] [PubMed] [Google Scholar]
  43. Robins-Browne R. M., Mackenjee M. K., Bodasing M. N., Coovadia H. M. Treatment of Campylobacter-associated enteritis with erythromycin. Am J Dis Child. 1983 Mar;137(3):282–285. doi: 10.1001/archpedi.1983.02140290068018. [DOI] [PubMed] [Google Scholar]
  44. SCHULTZ S. G., ZALUSKY R. ION TRANSPORT IN ISOLATED RABBIT ILEUM. II. THE INTERACTION BETWEEN ACTIVE SODIUM AND ACTIVE SUGAR TRANSPORT. J Gen Physiol. 1964 Jul;47:1043–1059. doi: 10.1085/jgp.47.6.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Saavedra J. M., Harris G. D., Li S., Finberg L. Capillary refilling (skin turgor) in the assessment of dehydration. Am J Dis Child. 1991 Mar;145(3):296–298. doi: 10.1001/archpedi.1991.02160030064022. [DOI] [PubMed] [Google Scholar]
  46. Salazar-Lindo E., Sack R. B., Chea-Woo E., Kay B. A., Piscoya Z. A., Leon-Barua R., Yi A. Early treatment with erythromycin of Campylobacter jejuni-associated dysentery in children. J Pediatr. 1986 Aug;109(2):355–360. doi: 10.1016/s0022-3476(86)80404-8. [DOI] [PubMed] [Google Scholar]
  47. Sandhu B. K., Isolauri E., Walker-Smith J. A., Banchini G., Van Caillie-Bertrand M., Dias J. A., Guandalini S., Hoekstra J. H., Juntunen M., Kolacek S. A multicentre study on behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on Acute Diarrhoea. Early feeding in childhood gastroenteritis. J Pediatr Gastroenterol Nutr. 1997 May;24(5):522–527. doi: 10.1097/00005176-199705000-00006. [DOI] [PubMed] [Google Scholar]
  48. Santosham M., Daum R. S., Dillman L., Rodriguez J. L., Luque S., Russell R., Kourany M., Ryder R. W., Bartlett A. V., Rosenberg A. Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. N Engl J Med. 1982 May 6;306(18):1070–1076. doi: 10.1056/NEJM198205063061802. [DOI] [PubMed] [Google Scholar]
  49. Scott D. A., Edelman R. Treatment of gastrointestinal infections. Baillieres Clin Gastroenterol. 1993 Jun;7(2):477–499. doi: 10.1016/0950-3528(93)90050-3. [DOI] [PubMed] [Google Scholar]
  50. Sharifi J., Ghavami F., Nowrouzi Z., Fouladvand B., Malek M., Rezaeian M., Emami M. Oral versus intravenous rehydration therapy in severe gastroenteritis. Arch Dis Child. 1985 Sep;60(9):856–860. doi: 10.1136/adc.60.9.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Sladen G. E., Dawson A. M. Interrelationships between the absorptions of glucose, sodium and water by the normal human jejunum. Clin Sci. 1969 Feb;36(1):119–132. [PubMed] [Google Scholar]
  52. Soriano-Brücher H. E., Avendaño P., O'Ryan M., Soriano H. A. Use of bismuth subsalicylate in acute diarrhea in children. Rev Infect Dis. 1990 Jan-Feb;12 (Suppl 1):S51–S56. doi: 10.1093/clinids/12.supplement_1.s51. [DOI] [PubMed] [Google Scholar]
  53. Sunderland R., Emery J. L. Apparent disapperance of hypernatraemic dehydration from infant deaths in Sheffield. Br Med J. 1979 Sep 8;2(6190):575–576. doi: 10.1136/bmj.2.6190.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Treem W. R. Congenital sucrase-isomaltase deficiency. J Pediatr Gastroenterol Nutr. 1995 Jul;21(1):1–14. doi: 10.1097/00005176-199507000-00001. [DOI] [PubMed] [Google Scholar]
  55. Vesikari T., Isolauri E. A comparative trial of cholestyramine and loperamide for acute diarrhoea in infants treated as outpatients. Acta Paediatr Scand. 1985 Sep;74(5):650–654. doi: 10.1111/j.1651-2227.1985.tb10006.x. [DOI] [PubMed] [Google Scholar]
  56. Victora C. G., Fuchs S. C., Kirkwood B. R., Lombardi C., Barros F. C. Breast-feeding, nutritional status, and other prognostic factors for dehydration among young children with diarrhoea in Brazil. Bull World Health Organ. 1992;70(4):467–475. [PMC free article] [PubMed] [Google Scholar]
  57. Walker-Smith J. A. Advances in the management of gastroenteritis in children. Br J Hosp Med. 1992 Nov 4;48(9):582–585. [PubMed] [Google Scholar]
  58. Walker-Smith J. A. Management of infantile gastroenteritis. Arch Dis Child. 1990 Sep;65(9):917–918. doi: 10.1136/adc.65.9.917. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Walker-Smith J. A., Sandhu B. K., Isolauri E., Banchini G., van Caillie-Bertrand M., Dias J. A., Fasano A., Guandalini S., Hoekstra J. H., Juntunen M. Guidelines prepared by the ESPGAN Working Group on Acute Diarrhoea. Recommendations for feeding in childhood gastroenteritis. European Society of Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1997 May;24(5):619–620. doi: 10.1097/00005176-199705000-00024. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES