Editor—We thank Goldman and Steinhertz for their helpful comments. Neither of us uses dicycloverine (dicyclomine) in managing babies with persistent crying, but, given that our article aimed to provide, as far as possible, an evidence linked summary of the evidence for managing persistent crying, we thought it important to mention the evidence underpinning treatment with dicycloverine.
Figure 1.
Two systematic reviews of randomised controlled trials have shown that dicycloverine is of benefit in infants with colic related persistent crying. The first review pooled results from five trials containing a total of 134 infants (age range 1-14 weeks) and found that dicycloverine was significantly more effective than placebo in reducing crying (standardised mean difference 0.46, 95% confidence interval 0.33 to 0.60).1
The second systematic review identified three randomised controlled trials included in the first review2; although results were not pooled, the authors came to a broadly similar conclusion about the effectiveness of dicycloverine.
As noted in our paper, there is also a risk of clinically important anticholinergic side effects. The evidence of benefit therefore needs to be balanced against known risks.3 Current consensus is that the risk profile of dicycloverine is such that it should not be given to infants under 6 months, and we concur with this position.4
Competing interests: None declared.
References
- 1.Lucassen PLBJ, Assendelft WJJ, Gubbels JW, van Eijk JTM, van Geldrop WJ, Neven K. Effectiveness of treatments for infantile colic: a systematic review. BMJ 1998;316: 1563-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000;106: 184-90. [PubMed] [Google Scholar]
- 3.Kilgour T, Wade S. Infantile colic. Clinical Evidence 2004. www.clinicalevidence.com/ceweb/conditions/chd/0309/0309.jsp (accessed 4 Mar 2004). [PubMed]
- 4.British Medical Association and Royal Pharmaceutical Society of Great Britain. British national formulary. London: BMA, RPS, 2003. (No 46.) www.bnf.org/ (accessed 1 Mar 2004).