Manejo de la gastroenteritis aguda en menores de 5 años: Un enfoque basado en la evidencia. Guía de práctica clínica Ibero-Latinoamericana
Anales de Pediatría 03/2010; 72(3):220.e1–220.e20. DOI: 10.1016/j.anpedi.2009.11.010
Acute gastroenteritis (AG) morbidity and mortality rates in infants and prescholars continue to be high in developing countries. Authors want to develop an evidence-based document that supports decision making regarding AG therapy in infants and children younger than 5 y/o. A systematic review of the literature was performed (May, 2008). Evidence grading was established according to Oxford guidelines and Latin American experts submitted their opinions on the recommendations generated.Oral rehydration solutions are the threatment's keystone for children with AG, showing lesser complications due to therapy than IV fluids. AG is no contraindication of a normal diet. Racecadotril, zinc and smectite can contribute to AG treatment, as well as Lactobacillus GG and Saccharomycces boulardii. No other drugs are recommended. It is recommended to treat children presenting AG with oral rehydration solutions among racecadotril, zinc or smectite as well as some probiotics.
Available from: Carlos Rodrigo
Available from: scielo.br
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ABSTRACT: In developing countries, millions of children suffer from severe diarrhoea every year. This is due to infection and malnutrition, and many die from dehydration due to the diarrhoea. Giving fluids by mouth (using an oral rehydration solution) has been shown to save children's lives, but it seems to have no effect on the length of time the children suffer with diarrhoea. Children in developing countries are often zinc deficient. This systematic review of 24 trials involving more than 9000 children shows that zinc supplementation may reduce the duration of diarrhoea in children aged six months or more.
Available from: Ivan D Florez
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Introduction: Ondansetron reduces hospitalization rates for diarrhea and vomiting in children, but is not yet routinely used.
Objective: To estimate from a social perspective the relative cost-effectiveness of ondansetron for the treatment of vomiting in children with gastroenteritis and at risk of dehydration in Colombia
Methods: Cost-effectiveness analysis from a social perspective, including direct medical costs and costs for caregivers. With a decision tree we compared costs and health outcomes of usual treatment without antiemetic to usual treatment plus ondansetron in children under 5 years with gastroenteritis and vomiting. Effectiveness of intervention was measured as reduction in hospitalization rates, and the time horizon of the model was the episode. Probabilities were obtained from clinical trials and systematic reviews, measurement of resources use was based on protocols and expert opinion, while unit costs were obtained from Colombian tariff manuals. We performed a survey to estimate indirect costs for caregivers (n=81) that included questions about wage loss, transportation, meals expenditures and other out-of-pocket payments. Deterministic and probabilistic sensitivity analyses were performed.
Results: Usual treatment plus ondansetron is a dominant strategy compared to usual treatment without antiemetic yielding fewer hospitalizations and saving $44.562 Colombian pesos (23,98USD) per episode. Ondansetron was dominant in 98,91% of simulations of the probabilistic analysis.
Conclusions: Ondansetron is a dominant intervention that reduces hospitalization rates and costs for health system and caregivers. We recommend assessing the inclusion of this drug in the Colombian Health Benefit Plan for the treatment of gastroenteritis in children under 5 years.
Keywords: Ondansetron, cost-effectiveness, Colombia, vomiting, diarrhea, hospitalization, gastroenteritis, children
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