Meta-analysis: Smectite in the treatment of acute infectious diarrhoea in children.

Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.48). 02/2006; 23(2):217-27. DOI: 10.1111/j.1365-2036.2006.02760.x
Source: PubMed

ABSTRACT Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrhoea in many countries.
To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhoea in children.
Using medical subject headings and free-language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhoea and smectite: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials were included.
Nine randomized-controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized-controlled trials showed that smectite significantly reduced the duration of diarrhoea compared with placebo. The pooled weighted mean difference was (-22.7 h, 95% CI: -24.8 to -20.6) with a fixed model and remained significant in a random effect model (-24.4 h, 95% CI: -29.8 to -19.1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1.64, 95% CI: 1.36-1.98; number needed to treat 4, 95% CI: 3-5). Adverse effects were similar in both groups.
Smectite may be a useful adjunct to rehydration therapy in treating acute paediatric gastroenteritis. However, the results of this meta-analysis should be interpreted with caution as most of the included studies had important limitations. Cost-effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended.

  • Pediatria polska 05/2013; 88(3):263-266. DOI:10.1016/j.pepo.2013.03.006
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    ABSTRACT: BACKGROUND: The plasma concentration of paraquat is closely related to the prognosis of patients with paraquat toxication, and the most common cause of death from paraquat poisoning is multiple organ failure (MOF). This study aimed to evaluate therapeutic effect of smecta on the plasma concentrations of paraquat and multi-organ injury induced by paraquat intoxication in rats. METHODS: A total of 76 healthy adult SD rats were randomly divided into group A (control group, n=6), group B (poisoned group, n=30) and group C (smecta-treated group, n=30). Rats in groups B and C were treated intragastrically with PQ at 50 mg/kg, and rats in group A was treated intragastrically with saline (1 mL). Rats in group C were given intragastrically smecta at 400 mg/kg 10 minutes after administration of PQ, while rats in other two groups were treated intragastrically with 1 mL saline at the same time. Live rats in groups B and C were sacrificed at 2, 6, 24, 48, 72 hours after administration of PQ for the determination of paraquat plasma concentrations and for HE staining of the lung, stomach and jejunum. The rats were executed at the end of trial by the same way in group A. RESULTS: The plasma concentration of paraquat (ng/mL) ranged from 440.314±49.776 to 4320.6150±413.947. Distinctive pathological changes were seen in the lung, stomach and jejunum in group B. Lung injuries deteriorated gradually, edema, leukocyte infiltration, pneumorrhagia, incrassated septa and lung consolidation were observed. Abruption of mucosa, hyperemic gastric mucosa and leukocyte infiltration were obvious in the stomach. The hemorrhage of jejunum mucosa, the abruption of villus, the gland damage with the addition of inflammatory cell infiltration were found. Compared to group B, the plasma concentration of paraquat reduced (P<0.01) and the pathological changes mentioned above were obviously alleviated in group C (P<0.05, P<0.01). CONCLUSION: Smecta reduced the plasma concentration of paraquat and alleviated pathologic injury of rats with PQ poisoning.
    03/2013; 4(2):144-50. DOI:10.5847/wjem.j.1920-8642.2013.02.011
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    ABSTRACT: Akute infektiöse Gastroenteritis 1. Definition und Basisinformation Die akute Gastroenteritis (AG) ist allgemein definiert als eine Abnahme der Stuhlkonsistenz (breiig oder flüs-sig) und/oder eine Zunahme der Stuhlfrequenz (typischer Weise drei oder mehr in 24 h), mit oder ohne Fie-ber oder Erbrechen. Die Durchfälle dauern meistens <7 Tage und nicht länger als 14 Tage. Die Veränderun-gen der Stuhlkonsistenz gegenüber dem für das Kind gewöhnlichen Stuhlverhalten ist hinweisender auf eine AG als die Stuhlfrequenz, besonders in den ersten Lebensmonaten. Die akute Gastroenteritis ist im Säuglings-und Kleinkindesalter häufig, in den ersten 3 Jahren beträgt die Häufigkeit 0.9 – 1,9 Episoden pro Kind pro Jahr. Etwa jedes 5. Kind <5 Jahren wird wegen akuter Gastro-enteritis (AG) mindestens einmal im Jahr beim Arzt vorgestellt, ~ 75% der erkrankten Kinder sind zwischen 6 und 24 Monaten. Etwa jedes 10. Kind in dieser Altersklasse, das dem Arzt wegen AG vorgestellt wird, wird stationär eingewiesen. Durch den schweren Wasser-und Elektrolytverlust kommt es zur Dehydration. Der Typ der Dehydration, isoton, hypoton oder hyperton, ist unabhängig vom Erreger. Der Flüssigkeitsverlust kann das Ein-, Zwei-bis Dreifache des zirkulierenden Blutvolumens betragen (80-150-250 ml/kg Körper-gewicht/Tag). Um das Blutvolumen konstant zu halten, entzieht der Körper dem Intrazellulärraum Flüssigkeit. Dies führt zur Exsikkose.

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