Comparative efficacy of rice-ORS and glucose-ORS in moderately dehydrated Turkish children with diarrhea.
ABSTRACT The efficacy of precooked rice-based (50 g/L) oral rehydration solution (R-ORS) was compared with standard glucose-based ORS (G-ORS) in a randomized controlled trial in 79 children who were moderately dehydrated due to diarrhea. ORS intake rate and weight gain after rehydration were found to be similar in the two treatment groups (p > 0.05). The time necessary for rehydration was significantly lower in the R-ORS-treated group than in the G-ORS-treated group (5.2 +/- 2.2 and 7.5 +/- 3.4 hours, respectively, p < 0.05). Although the mean serum bicarbonate levels were significantly increased in both treatment groups at the end of the treatment, a significant increase in the mean pH value was observed in only the R-ORS treated group (p < 0.05).
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ABSTRACT: Background Acute diarrhoea is one of the principal causes of morbidity and mortality among children in low-income countries. Glucose-based ORS helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization has recommended the osmolarity < 270 mOsm/L (ORS ≤ 270 ) over the > 310 mOsm/L formulation (ORS ≥ 310). Glucose polymer-based ORS (eg prepared using rice or wheat) slowly releases glucose and may be superior.Objectives To compare polymer-based ORS with glucose-based ORS for treating acute watery diarrhoea.Search strategyIn September 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and mRCT. We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.Selection criteriaRandomized controlled trials of people with acute watery diarrhoea (cholera and non-cholera associated) comparing polymer-based and glucose-based ORS (with identical electrolyte contents).Data collection and analysisTwo authors independently assessed the search results and risk of bias, and extracted data. In multiple treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.Main resultsThirty-four trials involving 4214 participants met the inclusion criteria: 27 in children, five in adults and two in both. Twelve trials used adequate methods to conceal allocation. Most compared polymer-based ORS with ORS ≥ 310. There were fewer unscheduled intravenous infusions in the polymer-based ORS group compared with glucose-based ORS (ORS ≥ 310 and ≤ 270 groups combined) (RR 0.75, 95% CI 0.59 to 0.95; 2235 participants, 19 trials). Adults positive for Vibrio cholerae had a shorter duration of diarrhoea with polymer-based ORS than with ORS ≤ 270 (MD -7.11 hours, SD -11.91 to -2.32; 228 participants, 4 trials). Wheat-based ORS resulted in lower total stool output in the first 24 hours compared with ORS ≤ 270 (MD -119.85 g/kg, SD -114.73 to -124.97; 129 participants, 2 trials). Adverse effects were similar for polymer-based ORS and glucose-based ORS.Authors' conclusionsPolymer-based ORS shows some advantages compared to ORS ≥ 310 for treating all-cause diarrhoea, and in diarrhoea caused by cholera. Comparisons favoured the polymer-based ORS over ORS ≤ 270, but the analysis was underpowered. If specialists consider a potential role for polymer-based ORS, further trials against the current standard (ORS ≤ 270) will be required.Plain Language SummaryPolymer-based oral rehydration solution (ORS) ORS for acute diarrhoeaAcute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea.Most ORS is in the form of a sugar–salt solution, but over the years people have tried adding a variety of compounds ('glucose polymers') such as whole rice, wheat, sorghum, and maize. The aim is to slowly release glucose into the gut and improve the absorption of the water and salt in the solution. This review updates and expands on a 1998 Cochrane Review of rice-based ORS, and assesses the available evidence on the use of polymer-based ORS (both rice and non-rice based) in comparison with the glucose-based ORS.The original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310). Glucose-based ORS with a lower osmolarity was later introduced in attempts to improve efficacy, and is considered better at reducing the amount and duration of diarrhoea.Thirty-four trials involving 4214 participants met the inclusion criteria: 27 in children; five in adults; and two in both. Most trials compared polymer-based ORS with a sugar–salt ORS with a particular strength (ORS ≥ 310), which is slightly more salty than the currently agreed best formula (≤ 270 mOsm/L). The trials' methodological quality was variable.Fewer people in the polymer-based ORS group needed a drip to be rehydrated compared with those in the glucose-based ORS group. Adverse events were similar for polymer-based ORS and glucose-based ORS.The authors conclude that polymer-based ORS show some advantages compared to glucose-based ORS for treating diarrhoea of any cause and in diarrhoea caused by cholera. Limited evidence favoured the polymer-based ORS over ORS ≤ 270. Further trials should compare the efficiency of ORS ≤ 270 with a polymer-based ORS.Evidence-Based Child Health A Cochrane Review Journal 12/2010; 5(4):1612 - 1675. DOI:10.1002/ebch.617
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ABSTRACT: Most diarrhoeal deaths can be prevented through the prevention and treatment of dehydration. Oral rehydration solution (ORS) and recommended home fluids (RHFs) have been recommended since 1970s and 1980s to prevent and treat diarrhoeal dehydration. We sought to estimate the effects of these interventions on diarrhoea mortality in children aged <5 years. We conducted a systematic review to identify studies evaluating the efficacy and effectiveness of ORS and RHFs and abstracted study characteristics and outcome measures into standardized tables. We categorized the evidence by intervention and outcome, conducted meta-analyses for all outcomes with two or more data points and graded the quality of the evidence supporting each outcome. The CHERG Rules for Evidence Review were used to estimate the effectiveness of ORS and RHFs against diarrhoea mortality. We identified 205 papers for abstraction, of which 157 were included in the meta-analyses of ORS outcomes and 12 were included in the meta-analyses of RHF outcomes. We estimated that ORS may prevent 93% of diarrhoea deaths. ORS is effective against diarrhoea mortality in home, community and facility settings; however, there is insufficient evidence to estimate the effectiveness of RHFs against diarrhoea mortality.International Journal of Epidemiology 04/2010; 39 Suppl 1(Suppl 1):i75-87. DOI:10.1093/ije/dyq025 · 9.20 Impact Factor