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What is already known on this topic? Diosmectite may be a useful additive in the treatment of acute childhood diarrhoea.
What this study adds? There is 'low quality' evidence that diosmectite may be a useful additive in the treatment of acute childhood diarrhoea.
We need future research to have higher quality designs before any firm recommendations can be made.
Introduction
Acute diarrhoea kills more than 1.5 million children under 5 years of age every year globally, and is the second most common cause of death in this age group. 1 The mainstay of treatment of an acute diarrhoeal episode includes oral rehydration therapy (ORT) and zinc. 2 ORT aims to prevent or reverse dehydration, and has no effect either on the duration of diarrhoea or on the stool output. Zinc is not universally effective in the treatment of acute diarrhoea, and has been used mainly in developing country settings. 3 For this reason, various medications and supplements (eg, loperamide, probiotics, prebiotics) have been studied in the treatment of acute childhood diarrhoea. 4 5 However, there is lack of evidence of efficacy and some (eg, loperamide) may even have serious side effects. 5
Diosmectite is a natural mineral clay having wide-ranging action on the gastrointestinal tract; they absorb bacteria, their toxins (endotoxin and exotoxin) and rotavirus; they increase water and electrolyte absorption and restore the barrier properties of intestinal epithelium after exposure to tumour necrosis factor [alpha]. 6-11
A previous meta-analysis published in 2006 showed that diosmectite was associated with a moderate reduction in the duration of diarrhoea in children with acute infectious gastroenteritis. 12 Many trials have been published after this. In order to provide the current best evidence and address some concerns (few trials contributing to the evidence, risk of publication bias and statistical conclusions based on heterogeneity) of the previous one, the present systematic review was conducted.
Methods
The review has been registered at the PROSPERO register: CRD42014013783.
Types of studies
Randomised controlled trials (RCTs) comparing diosmectite with placebo or no additional intervention with >=80% follow-up (to reduce the risk of attrition bias in the included studies in case intention-to-treat (ITT) analysis has not been done).
Types of participants
Children of both sexes and up to 5 years of age with acute diarrhoea...