Lippincott Williams & Wilkins



RISK FACTORS FOR SEVERE AND/OR PERSISTENT DISEASE Table 1.1. Is there a relationship between severe or persistent diarrhea and etiology?ReferenceStudy typePeriod of observationQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresRCT nEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Shai</Author><Year>2013</Year><RecNum>12387</RecNum><record><rec-number>12387</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shai, S.</author><author>Perez-Becker, R.</author><author>von Konig, C. H.</author><author>von Kries, R.</author><author>Heininger, U.</author><author>Forster, J.</author><author>Huppertz, H. I.</author><author>Roos, R.</author><author>Gobel, U.</author><author>Niehues, T.</author></authors></contributors><auth-address>HELIOS Klinikum Krefeld, Zentrum fur Kinder- und Jugendmedizin, Lutherplatz 40, 47805 Krefeld, Germany. sonu.shai@helios-kliniken.de</auth-address><titles><title>Rotavirus disease in Germany--a prospective survey of very severe cases</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>e62-7</pages><volume>32</volume><number>2</number><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-0987 (Electronic)&#xD;0891-3668 (Linking)</isbn><accession-num>22914558</accession-num><urls></urls></record></Cite></EndNote>Shai S, 2013Surveillance systemBetween April 2009 and March 2011+GermanyInpatientsN= 130 children younger than 17 years with very severe RV gastroenteritis (101 were verified)—Survey on hospital discharge data——NoNo. of severe RV gastroenteritis (N° nosocomial)—Number 17/101RV infection can have a life-threatening courseIncidence of very severe RV diarrhea in childrenless than 5 years of age;Incidence rates1.2/100,000/year ( 0.9–1.4/100,000) ADDIN EN.CITE <EndNote><Cite><Author>Valentini</Author><Year>2013</Year><RecNum>12388</RecNum><record><rec-number>12388</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Valentini, D.</author><author>Vittucci, A. C.</author><author>Grandin, A.</author><author>Tozzi, A. E.</author><author>Russo, C.</author><author>Onori, M.</author><author>Menichella, D.</author><author>Bartuli, A.</author><author>Villani, A.</author></authors></contributors><auth-address>Department of Pediatrics, Bambino Gesu Children&apos;s Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy, diletta.valentini@.</auth-address><titles><title>Coinfection in acute gastroenteritis predicts a more severe clinical course in children</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>909-15</pages><volume>32</volume><dates><year>2013</year><pub-dates><date>Jan 31</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>23370970</accession-num><urls></urls></record></Cite></EndNote>Valentini D, 2013Prospective cohort studyMarch 2010 to April 2011+ItalyInpatientsN=232 between 1 month and 16 years of age admitted for AGE—Collection of clinical data and stool samplesCoinfections vs Monoinfections232/275NoMax. no of diarrhea stools/24 h (≥6)—OR (95%CI)8.79 (3.32;23.28) p <0.001Coinfection with different pathogens is associated with a more severe course of symptomsDuration of diarrhea (days) (≥5)3.81 (1.47;9.86) p= 0.006Duration of vomiting (days) (≥3)7.11 (2.74;18.42) p<0.001Fever (≥38°)17.78 (2.32;136.17) p=0.006Severe dehydration (%)28.70 (3.04;270.6) p=0.003 ADDIN EN.CITE <EndNote><Cite><Author>Friesema</Author><Year>2012</Year><RecNum>9316</RecNum><record><rec-number>9316</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Friesema, I. H.</author><author>de Boer, R. F.</author><author>Duizer, E.</author><author>Kortbeek, L. M.</author><author>Notermans, D. W.</author><author>Norbruis, O. F.</author><author>Bezemer, D. D.</author><author>van Heerbeek, H.</author><author>van Andel, R. N.</author><author>van Enk, J. G.</author><author>Fraaij, P. L.</author><author>Koopmans, M. P.</author><author>Kooistra-Smid, A. M.</author><author>van Duynhoven, Y. T.</author></authors></contributors><auth-address>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, PBox 1, 3720 BA, Bilthoven, The Netherlands. ingrid.friesema@rivm.nl</auth-address><titles><title>Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>405-15</pages><volume>31</volume><number>4</number><keywords><keyword>Adolescent</keyword><keyword>Bacterial Infections/ epidemiology/microbiology</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Feces/microbiology/parasitology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/ etiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Netherlands/epidemiology</keyword><keyword>Parasitic Diseases/ epidemiology/parasitology</keyword><keyword>Questionnaires</keyword><keyword>Virus Diseases/ epidemiology/virology</keyword><keyword>Viruses/classification/isolation &amp; purification</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>21725865</accession-num><urls></urls></record></Cite></EndNote>Friesema IH, 2012Case-control studyMay 2008 to November 2009+The NetherlandsInpatientsN=144 (+63 controls) children 0 -15 yr (73% being<2 yr), admitted for severe AGE—Collection of clinical data and stool samplesDiarrhea vs not diarrhea143/144NoPathogens isolated from children (0-1yr) hospitalized with gastroenteritis (N=51)—RatesVirus: 50/51(98%) [RV 65%, Adeno 31%, NV 23%]; Bacteria 12/51 (23%) [Campylobacter 4%, EPEC 16%, EAEC 4%]; Parasites 0%Importance of viral pathogens, especially RV, in hospitalizations of children with gastroenteritis.Pathogens isolated from children (1-2yr) hospitalized with gastroenteritis (N=23)RatesVirus: 21/23(91%) [RV 70%, Adeno 13%, NV 10%]; Bacteria 7/23 (30%) [Salmonella 10%, EPEC 13%]; Parasites 10%Pathogens isolated from children (2-4yr) hospitalized with gastroenteritis (N=16)RatesVirus: 7/16 (44%) [RV 31%, Adeno 12%, NV 7%]; Bacteria 8/16 (50%) [Salmonella 31%]; Parasites 31%Pathogens isolated from children (>4yr) hospitalized with gastroenteritis (N=6)RatesVirus: 1/6 (17%) [RV 17%]; Bacteria 4/6 (67%) [Salmonella 50%]; Parasites 20%Consumption of eggsOR (95%CI)4.25; (1.06–17.06) p<0.05Consumption of fishOR (95%CI)0.08; (0.01–0.97) p<0.05 ADDIN EN.CITE <EndNote><Cite><Author>Oldak</Author><Year>2012</Year><RecNum>9315</RecNum><record><rec-number>9315</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Oldak, E.</author><author>Sulik, A.</author><author>Rozkiewicz, D.</author><author>Liwoch-Nienartowicz, N.</author></authors></contributors><auth-address>Department of Paediatric Infectious Diseases, Medical University of Bialystok, University Children&apos;s Hospital, Waszyngtona 17, 15-274, Bialystok, Poland. elzbieta.oldak@umb.edu.pl</auth-address><titles><title>Norovirus infections in children under 5 years of age hospitalized due to the acute viral gastroenteritis in northeastern Poland</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>417-22</pages><volume>31</volume><number>4</number><keywords><keyword>Caliciviridae Infections/ epidemiology/pathology/virology</keyword><keyword>Child, Preschool</keyword><keyword>Coinfection/epidemiology</keyword><keyword>Feces/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/ virology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Norovirus/ isolation &amp; purification</keyword><keyword>Poland/epidemiology</keyword><keyword>Prevalence</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/pathology/virology</keyword><keyword>Seasons</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>21732202</accession-num><urls></urls></record></Cite></EndNote>Oldak E, 2012Prospective cohort studyJuly 2009 and June 2010+PolandInpatientsN=242 children <5yr of age admitted for AGE—Collection of clinical data and stool samplesRV vs NV infections242/242YesIsolation of pathogens—RatesRV 51/242 (21.1%) vs NV 35/242 (14.5%)NV are a relevant cause of acute, community acquired gastroenteritis in Polish childrenDuration of diarrhea (≥6 days)RatesRV 11/51 (21.6%) vs NV 4/35 (11.4%)p= 0.17Severity score (severe)RatesRV 22/51 (43%) vs NV 5/35 (14.3%) p<0.01 ADDIN EN.CITE <EndNote><Cite><Author>Ogilvie</Author><Year>2012</Year><RecNum>11909</RecNum><record><rec-number>11909</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ogilvie, I.</author><author>Khoury, H.</author><author>Goetghebeur, M. M.</author><author>El Khoury, A. C.</author><author>Giaquinto, C.</author></authors></contributors><auth-address>BioMedCom Consultants Inc., Montreal, QC, Canada.</auth-address><titles><title>Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review</title><secondary-title>BMC Infect Dis</secondary-title></titles><periodical><full-title>BMC Infect Dis</full-title></periodical><pages>62</pages><volume>12</volume><keywords><keyword>Child, Preschool</keyword><keyword>Community-Acquired Infections/economics/ epidemiology</keyword><keyword>Cross Infection/economics/ epidemiology</keyword><keyword>Europe/epidemiology</keyword><keyword>Gastroenteritis/economics/ epidemiology/virology</keyword><keyword>Health Care Costs/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Rotavirus Infections/economics/ epidemiology</keyword></keywords><dates><year>2012</year></dates><isbn>1471-2334 (Electronic)&#xD;1471-2334 (Linking)</isbn><accession-num>22429601</accession-num><urls></urls></record></Cite></EndNote>Ogilvie I, 2012Scoping review——Western EuropeInpatients76 studies from 16 countries on European children <5 yr of age with community-acquired and nosocomial diarrhea——Community acquired vs Nosocomial diarrhea——Patients with severe nosocomial RVGE in France, Italy, Spain and the UK2 (n=3734; n=251)Rates (%)42.6%RV gastroenteritis is a common disease associated with significant morbidity and costsacross Western EuropePatients with severe nosocomial RVGE in Austria, Germany, and SwitzerlandRates (%)24.4%, 30.2% and 40%Severe dehydration in children with community-acquired vs nosocomial gastroenteritis2 (Ireland n=663; Sweden n=984)Rates (%)80% vs 55% (Ireland) 10.8% vs 0.8% (Sweden)Mortality due to nosocomial RVGE (< vs > 12mo)1(n=10,990)Incidence rates0.74 per 100,000 vs 0.16 per 100,000 ADDIN EN.CITE <EndNote><Cite><Author>Lorrot</Author><Year>2011</Year><RecNum>9582</RecNum><record><rec-number>9582</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lorrot, M.</author><author>Bon, F.</author><author>El Hajje, M. J.</author><author>Aho, S.</author><author>Wolfer, M.</author><author>Giraudon, H.</author><author>Kaplon, J.</author><author>Marc, E.</author><author>Raymond, J.</author><author>Lebon, P.</author><author>Pothier, P.</author><author>Gendrel, D.</author></authors></contributors><auth-address>Service de Pediatrie, Hopital Robert Debre (APHP), Faculte de Medecine Denis Diderot, Paris 7, Paris, France. mathie.lorrot@rdb.aphp.fr</auth-address><titles><title>Epidemiology and clinical features of gastroenteritis in hospitalised children: prospective survey during a 2-year period in a Parisian hospital, France</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>361-8</pages><volume>30</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Bacterial Infections/ epidemiology/microbiology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/virology</keyword><keyword>Feces/ microbiology/ virology</keyword><keyword>France/epidemiology</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/virology</keyword><keyword>Genotype</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Paris/epidemiology</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/virology</keyword><keyword>Virus Diseases/ epidemiology/virology</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>21128089</accession-num><urls></urls></record></Cite></EndNote>Lorrot M, 2011Prospective cohort studyNovember 2001 to May 2004+FranceInpatientsN=457 children 0-15 yr of age admitted for severe AGE (Patients with chronic diarrhea >10 days were excluded)—Collection of clinical data and stool samplesRV vs NV infections457/457YesIsolation of pathogens (0-6mo) N=177—RatesRV 77 (43.5%) NV 15 (8.5%) Bacteria 8 (4%)NV are the second leading causative agent of gastroenteritis in hospitalized young children and such infections are less severe than those caused by RVIsolation of pathogens (6-12mo) N=106RatesRV 63 (59.4%) NV 10 (9.4%)Bacteria 2 (2%)Isolation of pathogens (12-24mo) N=102RatesRV 59 (57.8%) NV 8 (7.8%) Bacteria 4 (4%)Isolation of pathogens (24-60mo) N=49RatesRV 22 (44.9%) NV 3 (6.1%) Bacteria 6 (12%)Isolation of pathogens (>60mo) N=23RatesRV 4 (17.4%) NV 2 (8.7%) Bacteria 5 (20%)Length of hospitalization (days) (RV vs NV)Median ± SD3.02 (1.54) 1.85 (1.03) p<0.001Severity score (Vesikari) RV vs NVMedian ± SD12.6 (2.92) 10.47 (2.83) p<0.001Intravenous rehydration (%) RV vs NV (N=261, mixed infections excluded)Rates172 (77.13%) 21 (55.26%) p=0.005 ADDIN EN.CITE <EndNote><Cite><Author>Mrukowicz</Author><Year>1999</Year><RecNum>2587</RecNum><record><rec-number>2587</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mrukowicz, J. Z.</author><author>Krobicka, B.</author><author>Duplaga, M.</author><author>Kowalska-Duplaga, K.</author><author>Domanski, J.</author><author>Szajewska, H.</author><author>Kantecki, M.</author><author>Iwanczak, F.</author><author>Pytrus, T.</author></authors></contributors><auth-address>Second Department of Paediatrics, Polish-American Children&apos;s Hospital, Jagiellonian University, School of Medicine, Cracow, Poland.</auth-address><titles><title>Epidemiology and impact of rotavirus diarrhoea in Poland</title><secondary-title>Acta Paediatr Suppl</secondary-title></titles><periodical><full-title>Acta Paediatr Suppl</full-title></periodical><pages>53-60</pages><volume>88</volume><number>426</number><keywords><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology</keyword><keyword>Gastroenteritis/epidemiology/virology</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Length of Stay</keyword><keyword>Poland/epidemiology</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/ epidemiology</keyword><keyword>Seasons</keyword></keywords><dates><year>1999</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0803-5326 (Print)</isbn><accession-num>10088913</accession-num><urls></urls></record></Cite></EndNote>Mrukowicz JZ, 1999*Retrospective cohort study1994-96+PolandInpatientsN=953 children hospitalized for AGE—Hospital discharge dataRV vs not RV——Severe clinical conditions (Vesikari score >11) in children with RV associated diarrhea—Rates94% (61.6% of cases younger than five years) p<0.001RV is a leading aetiological agent of severe gastroenteritis in young children in Poland and that the burden of this infection is significant (1999)Duration of hospitalization (days)Median ± SD9.5 d (+/-9.8 d)*Ogilvie 2011 (systematic review) cited this study and concluded that data on the burden of RVGE in terms of mortality, morbidity and economic burden is limited for Central and Eastern Europe. ADDIN EN.CITE <EndNote><Cite><Author>Rimoldi</Author><Year>2011</Year><RecNum>12228</RecNum><record><rec-number>12228</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rimoldi, S. G.</author><author>Stefani, F.</author><author>Pagani, C.</author><author>Chenal, L. L.</author><author>Zanchetta, N.</author><author>Di Bartolo, I.</author><author>Lombardi, A.</author><author>Ruggeri, F. M.</author><author>Di Lillo, D.</author><author>Zuccotti, G. V.</author><author>Gismondo, M. R.</author></authors></contributors><auth-address>Microbiology Unit, University Hospital L. Sacco, Milan, Italy. Rimoldi.sara@hsacco.it</auth-address><titles><title>Epidemiological and clinical characteristics of pediatric gastroenteritis associated with new viral agents</title><secondary-title>Arch Virol</secondary-title></titles><periodical><full-title>Arch Virol</full-title></periodical><pages>1583-9</pages><volume>156</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Feces/virology</keyword><keyword>Gastroenteritis/ epidemiology/ virology</keyword><keyword>Human bocavirus/ isolation &amp; purification</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Italy/epidemiology</keyword><keyword>Norovirus/ isolation &amp; purification</keyword><keyword>Sapovirus/ isolation &amp; purification</keyword><keyword>Time Factors</keyword><keyword>Young Adult</keyword></keywords><dates><year>2011</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1432-8798 (Electronic)&#xD;0304-8608 (Linking)</isbn><accession-num>21643788</accession-num><urls></urls></record></Cite></EndNote>Rimoldi SG, 2011Prospective cohort studyJanuary 2008 to October 2009+ItalyInpatientsN=273 children, suffering from acute gastroenteritis, in the age range from 0 to 222 mo—Clinical data and stool samplesDifferent viruses-associated diarrhea——Severe clinical conditions (Vesikari score) in children 1-18mo with diarrhea—Median ± SDRV 2.9±2.8 vs NV 3.1±3.5 Boca 11.5±4.5 Adeno 0.2 (Adeno vs others p<0.001)The severity of AdV-associated infection was lower than for NoV, HRV and HBoV. ADDIN EN.CITE <EndNote><Cite><Author>Gimenez-Sanchez</Author><Year>2010</Year><RecNum>9956</RecNum><record><rec-number>9956</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gimenez-Sanchez, F.</author><author>Delgado-Rubio, A.</author><author>Martinon-Torres, F.</author><author>Bernaola-Iturbe, E.</author></authors></contributors><auth-address>.Pediatric Infectious Diseases Unit, Hospital Torrecardenas, Almeria, Spain. dr.gimenez@cajamar.es</auth-address><titles><title>Multicenter prospective study analysing the role of rotavirus on acute gastroenteritis in Spain</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>738-42</pages><volume>99</volume><number>5</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Feces/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ virology</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Immunoassay</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus/ isolation &amp; purification/pathogenicity</keyword><keyword>Rotavirus Infections/ complications</keyword><keyword>Severity of Illness Index</keyword><keyword>Spain</keyword></keywords><dates><year>2010</year><pub-dates><date>May</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>20096025</accession-num><urls></urls></record></Cite></EndNote>Gimenez-Sanchez F, 2010Prospective cohort studyJanuary, February and March of 2006+SpainInpatientsN=1192 children <5yr of age—Clinical data and stool samplesRV (n = 584) vs not RV (n = 503)——Severe clinical conditions (Merck scale) in children <5yr with diarrhea—Median ± SD14.2 (3.8) vs 11.0 (4.2) p<0.001RV is the primary causal agent of AGE in children under the age of 2 years in Spain and that it produces a more severe manifestationSevere clinical conditions (Merck scale) in children <5yr with diarrheaRates30% vs 12% p<0.001Severe dehydration (degree >6%)Rates51 (20.2%) 10 (11%) NS ADDIN EN.CITE <EndNote><Cite><Author>Wiegering</Author><Year>2011</Year><RecNum>11907</RecNum><record><rec-number>11907</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiegering, V.</author><author>Kaiser, J.</author><author>Tappe, D.</author><author>Weissbrich, B.</author><author>Morbach, H.</author><author>Girschick, H. J.</author></authors></contributors><auth-address>Pediatric Stem Cell Transplantation and Oncology Unit, Department of Pediatrics, University Hospital Wurzburg, Josef-Schneider-Str. 2, 97080 Wurzburg, Germany. Wiegering_V@klinik.uni-wuerzburg.de</auth-address><titles><title>Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>e401-7</pages><volume>15</volume><number>6</number><keywords><keyword>Adenoviridae/isolation &amp; purification</keyword><keyword>Adenoviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross Infection/epidemiology/microbiology/physiopathology/virology</keyword><keyword>Diarrhea/epidemiology/microbiology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/ physiopathology/virology</keyword><keyword>Germany/epidemiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Norovirus/isolation &amp; purification</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/physiopathology/virology</keyword><keyword>Salmonella Infections/epidemiology/microbiology/physiopathology</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>21489842</accession-num><urls></urls></record></Cite></EndNote>Wiegering V, 2011Retrospective cohort studyApril 1, 2005 to May 31, 2008+GermanyInpatients650 charts of children with AGE. 262 (43.8%) had RV, 188 (31.4%) NV, 58 (9.7%) AV, 47(7.9%) Salmonella.——Comparisons between all viral infections and Salmonella infection——Duration of diarrhea (all viral vs Salmonella)—Mean number ±SD3.4±0.1 vs 6.1±0.4, p<0.001Children with viral infection had significanlty more respiratory associated symptoms and vomiting, but less episodes of diarrhea and total duration of diarrhea when compared to children with Salmonella infection.Diarrhea events (all viral vs Salmonella)mean number ±SD3.8±0.1 vs 10.4±0.5, p<0.001Vomiting events (all viral vs Samonella)mean number ±SD2.6±0.2 vs 1±0.4, p<0.001Airway inflammation score (all viral vs Salmonella)mean number ±SD1.8±0.1 vs 0.6±0.3; p<0.001Gastroenteritis score (all viral vs Samonella and RV vs AV and NV)mean number ±SDAll viral 12.7±0.1 vs Salmonella 13.4±0.5, p=NS; RV 13.5± 0.2 vs AV and NV 11.9± 0.2 and 11.5±0.4 , p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Muhsen</Author><Year>2009</Year><RecNum>10071</RecNum><record><rec-number>10071</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Muhsen, K.</author><author>Shulman, L.</author><author>Rubinstein, U.</author><author>Kasem, E.</author><author>Kremer, A.</author><author>Goren, S.</author><author>Zilberstein, I.</author><author>Chodick, G.</author><author>Ephros, M.</author><author>Cohen, D.</author></authors></contributors><auth-address>Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.</auth-address><titles><title>Incidence, characteristics, and economic burden of rotavirus gastroenteritis associated with hospitalization of israeli children &lt;5 years of age, 2007-2008</title><secondary-title>J Infect Dis</secondary-title></titles><periodical><full-title>J Infect Dis</full-title></periodical><pages>S254-63</pages><volume>200 Suppl 1</volume><keywords><keyword>Child, Preschool</keyword><keyword>Cost of Illness</keyword><keyword>Female</keyword><keyword>Gastroenteritis/economics/ epidemiology/virology</keyword><keyword>Genotype</keyword><keyword>Health Expenditures</keyword><keyword>Hospitalization/ economics</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Israel/epidemiology</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Public Health</keyword><keyword>Rotavirus/classification/genetics</keyword><keyword>Rotavirus Infections/economics/ epidemiology/virology</keyword><keyword>Time Factors</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov 1</date></pub-dates></dates><isbn>1537-6613 (Electronic)&#xD;0022-1899 (Linking)</isbn><accession-num>19817606</accession-num><urls></urls></record></Cite></EndNote>Muhsen K, 2009MA1970s through 2009++Developing countriesInpatients and OutpatientsN=17030 mostly <6yr of age (1 case-control study 0-14 yr; 1 case-control study all ages); 13 case-control studies and 2 cohort studies—Detailed clinical history and laboratory investigationsAcute vs persistent diarrhea vs controls——Association between Giardia Lamblia and PD4 case-control, 1 cohort studyOR (95%CI)3.18 (1.50-6.76) p<0.0001G. lamblia was not associated with acute diarrhea. However, limited data suggest that initialGiardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a positive link with GiardiaAssociation between Giardia Lamblia and ADOR (95%CI)0.60 (0.38-0.94) p=0.03 ADDIN EN.CITE <EndNote><Cite><Author>Abba</Author><Year>2009</Year><RecNum>10308</RecNum><record><rec-number>10308</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abba, K.</author><author>Sinfield, R.</author><author>Hart, C. A.</author><author>Garner, P.</author></authors></contributors><auth-address>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. K.abba@liverpool.ac.uk</auth-address><titles><title>Antimicrobial drugs for persistent diarrhoea of unknown or non-specific cause in children under six in low and middle income countries: systematic review of randomized controlled trials</title><secondary-title>BMC Infect Dis</secondary-title></titles><periodical><full-title>BMC Infect Dis</full-title></periodical><pages>24</pages><volume>9</volume><keywords><keyword>Anti-Infective Agents/ therapeutic use</keyword><keyword>Asia, Southeastern/epidemiology</keyword><keyword>Child, Preschool</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea/ drug therapy/epidemiology</keyword><keyword>Gentamicins/therapeutic use</keyword><keyword>Guatemala/epidemiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Metronidazole/therapeutic use</keyword><keyword>Poverty</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Treatment Outcome</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination/therapeutic use</keyword></keywords><dates><year>2009</year></dates><isbn>1471-2334 (Electronic)&#xD;1471-2334 (Linking)</isbn><accession-num>19257885</accession-num><urls></urls></record></Cite></EndNote>Abba K, 2009Systematic reviewSearch date: May 20, 2008 (none after 2000)++Developing countriesInpatients and OutpatientsN=3832 children <6yr of age—Sample stoolsPersistent Diarrhea vs no diarrhea——RVWeighted mean percentagePD 5% vs no diarrhea 3%There is no evidence that any particular pathogen or type of pathogen is associated with persistent diarrhea in children under the age of six in low and middle income countries. There is therefore no evidence to justify routine antimicrobial use for children with persistent diarrhea of unknown cause, in keeping with current guidelines.Enteric AdenovirusWeighted mean percentagePD 5% vs no diarrhea 1%CampylobacterWeighted mean percentagePD 6% vs no diarrhea 8%Shigella7 (680 cases and 1021 controls)Weighted mean percentagePD 4% vs no diarrhea 2%Salmonella6 (510 cases and 857 controls)Weighted mean percentagePD 4% vs no diarrhea 0%Vibrio Cholerae3 (405 cases and 813 controls)Weighted mean percentagePD 0% vs no diarrhea 1%EPEC7 (550 cases and 604 controls)Weighted mean percentagePD 41% vs no diarrhea 30%EHEC2 (143cases and 143 controls)Weighted mean percentagePD 0% vs no diarrhea 0%Giardia8 (688cases and 1062 controls)Weighted mean percentagePD 10% vs no diarrhea 7%Cryptosporidium0Entamoeba histolytica5 (688 cases and 1063 controls)Weighted mean percentagePD 2% vs no diarrhea 3% ADDIN EN.CITE <EndNote><Cite><Author>Ochoa</Author><Year>2009</Year><RecNum>10049</RecNum><record><rec-number>10049</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ochoa, T. J.</author><author>Ecker, L.</author><author>Barletta, F.</author><author>Mispireta, M. L.</author><author>Gil, A. I.</author><author>Contreras, C.</author><author>Molina, M.</author><author>Amemiya, I.</author><author>Verastegui, H.</author><author>Hall, E. R.</author><author>Cleary, T. G.</author><author>Lanata, C. F.</author></authors></contributors><auth-address>Universidad Peruana Cayetano Heredia, Lima, Peru.</auth-address><titles><title>Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban areas in Lima, Peru</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>1694-702</pages><volume>49</volume><number>11</number><keywords><keyword>Age Factors</keyword><keyword>Diarrhea, Infantile/ epidemiology/ microbiology</keyword><keyword>Escherichia coli/genetics/ physiology</keyword><keyword>Escherichia coli Infections/ epidemiology/ microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Peru/epidemiology</keyword><keyword>Population Surveillance</keyword><keyword>Prevalence</keyword></keywords><dates><year>2009</year><pub-dates><date>Dec 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>19857163</accession-num><urls></urls></record></Cite></EndNote>Ochoa TJ, 2009Prospective cohort studySeptember-2006 and December-2007+PerùOutpatientsN=1034 children from 2 to 12 months of ageControls were selected randomly*A field worker visited control children at home to collect stool samples. A field worker visited children with diarrhea at home at least once a week until the episode ended.Diarrhea vs not diarrhea992/1034NoDuration of diarrhea in accordance to age*—Mean±SD7.1 ± 6.1 (children < 6mo) vs 4.9 ± 3.8 (children ≥ 6mo)Persistent diarrhea was more frequent in infants < 6mo of age. No specific bacterial species was associated with persistent diarrheaPersistent diarrhea**Rates13.5% (children < 6mo) vs 3.6% (children ≥ 6mo)Isolation of EAEC in stool coltures in children with persistent diarrheaRates14.1% (12/85)Isolation of EPEC in stool coltures in children with persistent diarrheaRates7.9% (3/38)Isolation of DAEC in stool coltures in children with persistent diarrheaRates15% (3/20)Isolation of ETEC in stool coltures in children with persistent diarrheaRates18.8% (3/16)Isolation of Campylobacter in stool coltures in children with persistent diarrheaRates2.9% (3/103)Isolation of Roatvirus in stool coltures in children with persistent diarrheaRates1.2% (1/85)Isolation of mixed pathogens in children with persistent diarrheaRates3.7% (4/109)*not specified how**diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Rivera</Author><Year>2010</Year><RecNum>9768</RecNum><record><rec-number>9768</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rivera, F. P.</author><author>Ochoa, T. J.</author><author>Maves, R. C.</author><author>Bernal, M.</author><author>Medina, A. M.</author><author>Meza, R.</author><author>Barletta, F.</author><author>Mercado, E.</author><author>Ecker, L.</author><author>Gil, A. I.</author><author>Hall, E. R.</author><author>Huicho, L.</author><author>Lanata, C. F.</author></authors></contributors><auth-address>Universidad Peruana Cayetano Heredia, Lima, Peru.</auth-address><titles><title>Genotypic and phenotypic characterization of enterotoxigenic Escherichia coli strains isolated from Peruvian children</title><secondary-title>J Clin Microbiol</secondary-title></titles><periodical><full-title>J Clin Microbiol</full-title></periodical><pages>3198-203</pages><volume>48</volume><number>9</number><keywords><keyword>Anti-Bacterial Agents/pharmacology</keyword><keyword>Antibodies, Bacterial/diagnostic use</keyword><keyword>Antibodies, Monoclonal/diagnostic use</keyword><keyword>Bacterial Toxins/biosynthesis/genetics</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology</keyword><keyword>Enterotoxigenic Escherichia coli/ classification/genetics/ isolation &amp;</keyword><keyword>purification/metabolism</keyword><keyword>Enterotoxins/biosynthesis/genetics</keyword><keyword>Enzyme-Linked Immunosorbent Assay/methods</keyword><keyword>Escherichia coli Infections/ microbiology</keyword><keyword>Escherichia coli Proteins/biosynthesis/genetics</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Peru</keyword><keyword>Polymerase Chain Reaction/methods</keyword><keyword>Virulence Factors/biosynthesis/genetics</keyword></keywords><dates><year>2010</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1098-660X (Electronic)&#xD;0095-1137 (Linking)</isbn><accession-num>20631096</accession-num><urls></urls></record></Cite></EndNote>Rivera FP, 2010Prospective cohort study26 months (September 2006-July 2008)+PerùOutpatientsN=1873 (1129 cases and 744 controls) children 2-24 months of age—Collection of stool samplesDiarrhea vs not diarrheaNONoClinical and epidemiological characteristics of ETEC diarrhea—RatesIsolated ETEC strains in cases (60/1129; 5.3%) and controls (32/744 ; 4.3%)The duration of diarrhea caused by ETEC-LT strains tended to be longer (up to 24 days).Persistent diarrhea* (single ETEC strain, N=38): 11%Persistent diarrhea (all ETEC isolates N=60): 8%Presence of ST (heat-stable toxin) and LT (heat-labile toxin)RatesPersistent diarrhea (ETEC-LT strain, N=31): 6%Persistent diarrhea (ETEC-ST isolates N=15): 0%**diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Moore</Author><Year>2010</Year><RecNum>9760</RecNum><record><rec-number>9760</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moore, S. R.</author><author>Lima, N. L.</author><author>Soares, A. M.</author><author>Oria, R. B.</author><author>Pinkerton, R. C.</author><author>Barrett, L. J.</author><author>Guerrant, R. L.</author><author>Lima, A. A.</author></authors></contributors><auth-address>Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children&apos;s Hospital Medical Center, Cincinnati, Ohio, USA. sean.moore@</auth-address><titles><title>Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>1156-64</pages><volume>139</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Ascariasis/complications</keyword><keyword>Breast Feeding</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Diarrhea/ etiology</keyword><keyword>Female</keyword><keyword>Growth Disorders/ etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology</keyword><keyword>Proportional Hazards Models</keyword><keyword>Risk</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1528-0012 (Electronic)&#xD;0016-5085 (Linking)</isbn><accession-num>20638937</accession-num><urls></urls></record></Cite></EndNote>Moore SR, 2010Prospective cohort study127 months (August 1989-March 2000)++BrazilOutpatientsN=414 children ≤ 5 years of age and newborns between August 1989 and March 2000—Nurses visit home of each newborn child 3 times a week for the first 45 mo. Then twice a week. Children with diarrhea were visited dailyDiarrhea vs not diarrhea414/414YesIsolation of Cryptosporidium species in stool coltures—Rates12/98 (12.2%) vs 15/289 (5.2%)Shigella and Cryptosporidium are significantly associated with prolonged episodes* of diarrhea, and both of them are related with growth faltering, especially in tropical and developing regions. Ascaris and multiple pathogens were found to be more frequent in controls than in children with persistent diarrhea**, due to a possible mitigating effect on the duration of intestinal infections by altering immune response.Isolation of Ascaris species in stool colturesRates7/132 (5.3%) vs 61/442 (13.8%)Isolation of bacteria in stool coltures (all species)Rates16/132 (12.1%) vs 8/442 (1.8%)Isolation of Shigella species in stool colturesRates6/132 (4.5%) vs 5/440 (1.1%)Fecal LeukocytesRates67/132 (50.8%) vs 28/442 (6.3%)LactoferrinRates27/35 (77.1%) vs 47/95 (49.5%)Multiple pathogensRates26/98 (26.5%) vs 82/194 (40.7%)*Prolonged diarrhea= 7-13th day**Diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Allison</Author><Year>2011</Year><RecNum>9314</RecNum><record><rec-number>9314</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allison, G. M.</author><author>Rogers, K. A.</author><author>Borad, A.</author><author>Ahmed, S.</author><author>Karim, M. M.</author><author>Kane, A. V.</author><author>Hibberd, P. L.</author><author>Naumova, E. N.</author><author>Calderwood, S. B.</author><author>Ryan, E. T.</author><author>Khan, W. A.</author><author>Ward, H. D.</author></authors></contributors><auth-address>Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. gallison@</auth-address><titles><title>Antibody responses to the immunodominant Cryptosporidium gp15 antigen and gp15 polymorphisms in a case-control study of cryptosporidiosis in children in Bangladesh</title><secondary-title>Am J Trop Med Hyg</secondary-title></titles><periodical><full-title>Am J Trop Med Hyg</full-title></periodical><pages>97-104</pages><volume>85</volume><number>1</number><keywords><keyword>Animals</keyword><keyword>Antibodies, Protozoan/ biosynthesis</keyword><keyword>Antigens, Protozoan/genetics/ immunology</keyword><keyword>Bangladesh</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Cryptosporidiosis/ immunology</keyword><keyword>Cryptosporidium/ immunology</keyword><keyword>Diarrhea/ immunology/parasitology</keyword><keyword>Enzyme-Linked Immunosorbent Assay</keyword><keyword>Humans</keyword><keyword>Immunoglobulin G/biosynthesis</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Polymorphism, Genetic</keyword></keywords><dates><year>2011</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1476-1645 (Electronic)&#xD;0002-9637 (Linking)</isbn><accession-num>21734132</accession-num><urls></urls></record></Cite></EndNote>Allison GM, 2011Case-control study—+BangladeshInpatientsN=92 children from 15 days to 60 mo of age with diarrhea (46 controls with negative stool coltures for Cryptosporidium; subsequently 7 controls were founf positive for PCR and were thus considered cases)—Detailed clinical history and laboratory investigationsPositive for Cryptosp. vs Negative for Cryptosp.50/92 (33 cases) - 3 weeksNoN° of persistent diarrhea* (Cases vs controls)—Rates37% (18/47) vs 0% (0/39)In Bangladesh, wherecryptosporidiosis is endemic, it is associated with persistent diarrhea*. Although the dominant antibody response appears to be targeted to conserved peptide epitopes of g15, antibody responses to polymorphic, species- or subtype specific epitopes may also occur. These findings have implications for development of gp15 as a putative vaccine candidateAntibody (IgG) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]68 [28; 110] vs 4 [0; 10]Antibody (IgM) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]?29 [–97; 13] vs 0 [–; 0]Antibody (IgA) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]83 [19; 243] vs 40 [3; 61]Antibody (IgG) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]62 [19; 124] vs 0 [–7; 7]Antibody (IgM) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]2 [–20; 20] vs 0 [–7; –8]Antibody (IgA) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]50 [10; 138] vs 4 [–1; 24]*Diarrhea lasting > 14 days was considered persistentAGE= Acute gastroenteritis; AV= Adenovirus; DAEC= diffusely adherent Escherichia coli; EAEC=Enteroaggregative Escherichia coli; EPEC=enteropathogenic Escherichia coli; ETEC= Enterotoxigenic Escherichia coli; LT=heat-labile toxin; NV= Norovirus; OR=odd ratio; QoS=Quality of Study; RV=Rotavirus; RVGE= Rotavirus gastroenteritis; SD=standard deviation; ST= heat-stable toxin. 1.2. Is there a relationship between host-related factors and risk of severe or persistent diarrhea?Table 1.2.1. Risk factor: younger ageReferenceStudy typePeriod of observationQoSCountryIn/Out PatientsPopulationInterventionComparisonFU n/NITTOutcomes measuresEffect measureEffect size Comments ADDIN EN.CITE <EndNote><Cite><Author>Friesema</Author><Year>2012</Year><RecNum>9316</RecNum><record><rec-number>9316</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Friesema, I. H.</author><author>de Boer, R. F.</author><author>Duizer, E.</author><author>Kortbeek, L. M.</author><author>Notermans, D. W.</author><author>Norbruis, O. F.</author><author>Bezemer, D. D.</author><author>van Heerbeek, H.</author><author>van Andel, R. N.</author><author>van Enk, J. G.</author><author>Fraaij, P. L.</author><author>Koopmans, M. P.</author><author>Kooistra-Smid, A. M.</author><author>van Duynhoven, Y. T.</author></authors></contributors><auth-address>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, PBox 1, 3720 BA, Bilthoven, The Netherlands. ingrid.friesema@rivm.nl</auth-address><titles><title>Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>405-15</pages><volume>31</volume><number>4</number><keywords><keyword>Adolescent</keyword><keyword>Bacterial Infections/ epidemiology/microbiology</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Feces/microbiology/parasitology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/ etiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Netherlands/epidemiology</keyword><keyword>Parasitic Diseases/ epidemiology/parasitology</keyword><keyword>Questionnaires</keyword><keyword>Virus Diseases/ epidemiology/virology</keyword><keyword>Viruses/classification/isolation &amp; purification</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>21725865</accession-num><urls></urls></record></Cite></EndNote>Friesema IH, 2012Case-control studyMay 2008 to November 2009+The NetherlandsInpatientsN=144 (+63 controls) children 0 -15 yr (73% being <2 yr), admitted for severe AGECollection of clinical data and stool samplesDiarrhea vs not diarrhea143/144NoPathogens isolated from children (0-1yr) hospitalized with gastroenteritis (N=51)RatesVirus: 50/51(98%) [RV 65%, Adeno 31%, NV 23%]; Bacteria 12/51 (23%) [Campylobacter 4%, EPEC 16%, EAEC 4%]; Parasites 0%Importance of viral pathogens, especially RV, in hospitalizated children with gastroenteritisPathogens isolated from children (1-2yr) hospitalized with gastroenteritis (N=23)RatesVirus: 21/23(91%) [RV 70%, Adeno 13%, NV 10%]; Bacteria 7/23 (30%) [Salmonella 10%, EPEC 13%]; Parasites 10%Pathogens isolated from children (2-4yr) hospitalized with gastroenteritis (N=16)RatesVirus: 7/16 (44%) [RV 31%, Adeno 12%, NV 7%]; Bacteria 8/16 (50%) [Salmonella 31%]; Parasites 31%Pathogens isolated from children (>4yr) hospitalized with gastroenteritis (N=6)RatesVirus: 1/6 (17%) [RV 17%]; Bacteria 4/6 (67%) [Salmonella 50%]; Parasites 20% ADDIN EN.CITE <EndNote><Cite><Author>Lorrot</Author><Year>2011</Year><RecNum>12347</RecNum><record><rec-number>12347</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lorrot, M.</author><author>Bon, F.</author><author>El Hajje, M. J.</author><author>Aho, S.</author><author>Wolfer, M.</author><author>Giraudon, H.</author><author>Kaplon, J.</author><author>Marc, E.</author><author>Raymond, J.</author><author>Lebon, P.</author><author>Pothier, P.</author><author>Gendrel, D.</author></authors></contributors><auth-address>Service de Pediatrie, Hopital Robert Debre (APHP), Faculte de Medecine Denis Diderot, Paris 7, Paris, France. mathie.lorrot@rdb.aphp.fr</auth-address><titles><title>Epidemiology and clinical features of gastroenteritis in hospitalised children: prospective survey during a 2-year period in a Parisian hospital, France</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>361-8</pages><volume>30</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Bacterial Infections/ epidemiology/microbiology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/virology</keyword><keyword>Feces/ microbiology/ virology</keyword><keyword>France/epidemiology</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/virology</keyword><keyword>Genotype</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Paris/epidemiology</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/virology</keyword><keyword>Virus Diseases/ epidemiology/virology</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>21128089</accession-num><urls></urls></record></Cite></EndNote>Lorrot M, 2011Prospective cohort studyNovember 2001 to May 2004+FranceInpatientsN=457 children 0-15 yr of age admitted for severe AGE (Patients with chronic diarrhea >10 days were excluded)Collection of clinical data and stool samplesComparing children basing on clinical conditions and age457/457YesIsolation of pathogens (0-6mo) N=177RatesRV 77 (43.5%) NV 15 (8.5%) Bacteria 8 (4%)Main role of RV in hospitalized gastroenteritis among Frenchchildren less than 2 years of ageIsolation of pathogens (6-12mo) N=106RatesRV 63 (59.4%) NV 10 (9.4%)Bacteria 2 (2%)Isolation of pathogens (12-24mo) N=102RatesRV 59 (57.8%) NV 8 (7.8%) Bacteria 4 (4%)Isolation of pathogens (24-60mo) N=49RatesRV 22 (44.9%) NV 3 (6.1%) Bacteria 6 (12%)Isolation of pathogens (>60mo) N=23RatesRV 4 (17.4%) NV 2 (8.7%) Bacteria 5 (20%)Lenght of hospitalization (days) in children 0-6 mo (RV vs NV)Median ± SDRV 3.26 (±1.84) NV 2.17 (±1.06) p=0.0293Lenght of hospitalization (days) in children 6-24 mo (RV vs NV)Median ± SDRV 2.90 (±1.39) NV 1.78 (±1.06) p=0.0013Lenght of hospitalization (days) in children >24mo (RV vs NV)Median ± SDRV 2.85 (±1.26) NV 1.2 (±0.45) p=0.0078 3.02Lenght of hospitalization (days) (RV vs NV)Median ± SD3.02 (1.54) 1.85 (1.03) p<0.001Severity score (Vesikari) in children 0-6 mo (RV vs NV)Median ± SDNSSeverity score (Vesikari) in children 6-24 mo (RV vs NV)Median ± SD13.48 (±2.54) 11.39 (±3.05) p<0.002Severity score (Vesikari) in children 24 mo (RV vs NV)Median ± SD12.88 (±2.94) 8.8 (±2.28) p=0.007Intravenous rehydration (%) in children 0-6mo; RV vs NV (N=261, mixed infections excluded)RatesNSIntravenous rehydration (%) in children 6-24mo; RV vs NV (N=261, mixed infections excluded)Rates107 (87.7%) 12 (66.67%) p=0.031Intravenous rehydration (%) RV vs NV (N=261, mixed infections excluded)RatesNS ADDIN EN.CITE <EndNote><Cite><Author>Moore</Author><Year>2010</Year><RecNum>9760</RecNum><record><rec-number>9760</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moore, S. R.</author><author>Lima, N. L.</author><author>Soares, A. M.</author><author>Oria, R. B.</author><author>Pinkerton, R. C.</author><author>Barrett, L. J.</author><author>Guerrant, R. L.</author><author>Lima, A. A.</author></authors></contributors><auth-address>Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children&apos;s Hospital Medical Center, Cincinnati, Ohio, USA. sean.moore@</auth-address><titles><title>Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>1156-64</pages><volume>139</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Ascariasis/complications</keyword><keyword>Breast Feeding</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Diarrhea/ etiology</keyword><keyword>Female</keyword><keyword>Growth Disorders/ etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology</keyword><keyword>Proportional Hazards Models</keyword><keyword>Risk</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1528-0012 (Electronic)&#xD;0016-5085 (Linking)</isbn><accession-num>20638937</accession-num><urls></urls></record></Cite></EndNote>Moore SR, 2010Prospective cohort study127 months (August 1989-March 2000)++BrazilOutpatientsN=414 children ≤ 5 years of age and newborns between August 1989 and March 2000Nurses visit home of each newborn child 3 times a week for the first 45 mo. Then twice a week. Children with diarrhea were visited dailyDiarrhea vs not diarrhea414/414YesAge-specific attack ratesRatesTotal, AD, and PD all peaked at 6-12 months of age (5.15, 4.22, and 0.68 episodes per child-year, respectively).Infants with Prolonged diarrhea have a higher risk of developing PD in later childhood. *Children with PD who experienced also ProD episode; children in the first year of lifeRates57/71 (80.3%); 30/57 (52.6%)Risk to develop PD in children who experienced ProD in their first year of life OR2.2, 95% CI; [1.32-3.54], P=0.002*Prolonged diarrhea= 7-13th day, diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Pathela</Author><Year>2006</Year><RecNum>12389</RecNum><record><rec-number>12389</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pathela, P.</author><author>Zahid Hasan, K.</author><author>Roy, E.</author><author>Huq, F.</author><author>Kasem Siddique, A.</author><author>Bradley Sack, R.</author></authors></contributors><auth-address>Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.</auth-address><titles><title>Diarrheal illness in a cohort of children 0-2 years of age in rural Bangladesh: I. Incidence and risk factors</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>430-7</pages><volume>95</volume><number>4</number><keywords><keyword>Bangladesh</keyword><keyword>Cohort Studies</keyword><keyword>Diarrhea, Infantile/ epidemiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant Nutritional Physiological Phenomena</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Rural Health</keyword><keyword>Seasons</keyword><keyword>Socioeconomic Factors</keyword><keyword>Water Supply</keyword></keywords><dates><year>2006</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0803-5253 (Print)&#xD;0803-5253 (Linking)</isbn><accession-num>16720490</accession-num><urls></urls></record></Cite></EndNote>Pathela P, 2006Prospective cohort study1993-1996+BangladeshOutpatientsN= 252 children < 5yr of ageDoor-to-door censusconducted by community health workersAge groups244/252YESRisk to develop PD (n° episodes per child year) in children 0-5 moIncidence Rates0.4 (45); p < 0.001Significant differences between 0 /5-month age groups and all other age groupsRisk to develop PD in children 18-23 moOR (95%CI)0.59 (0.48 /0.73); p<0.001When adjustment for othercovariates was done, the relative odds of diarrhea in the older age groups were lower compared to the youngest age group. ADDIN EN.CITE <EndNote><Cite><Author>Pereira</Author><Year>2007</Year><RecNum>11085</RecNum><record><rec-number>11085</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pereira, A. L.</author><author>Ferraz, L. R.</author><author>Silva, R. S.</author><author>Giugliano, L. G.</author></authors></contributors><auth-address>Laboratorio de Microbiologia, Departamento de Biologia Celular, Universidade de Brasilia, Brasilia, Brazil.</auth-address><titles><title>Enteroaggregative Escherichia coli virulence markers: positive association with distinct clinical characteristics and segregation into 3 enteropathogenic E. coli serogroups</title><secondary-title>J Infect Dis</secondary-title></titles><periodical><full-title>J Infect Dis</full-title></periodical><pages>366-74</pages><volume>195</volume><number>3</number><keywords><keyword>Bacterial Adhesion/genetics</keyword><keyword>Bacterial Toxins/genetics</keyword><keyword>Brazil</keyword><keyword>Case-Control Studies</keyword><keyword>Diarrhea, Infantile/ microbiology</keyword><keyword>Enterotoxins/genetics</keyword><keyword>Escherichia coli Infections/ microbiology/pathology</keyword><keyword>Escherichia coli O157/chemistry/ classification/pathogenicity</keyword><keyword>Escherichia coli Proteins/ genetics</keyword><keyword>Fimbriae Proteins/genetics</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Serotyping</keyword><keyword>Species Specificity</keyword><keyword>Virulence</keyword></keywords><dates><year>2007</year><pub-dates><date>Feb 1</date></pub-dates></dates><isbn>0022-1899 (Print)&#xD;0022-1899 (Linking)</isbn><accession-num>17205475</accession-num><urls></urls></record></Cite></EndNote>Pereira AL, 2007Case-control studyNot specified+BrasilInpatientsN=261 (134 cases and 127 controls) ≤ 5 years of age; controls were defined as children who did not present with diarrhea in the 4 weeks before sample collectionCollection of stool samplesAcute vs persistent diarrhea vs controls—YESDetection of EAEC virulance markers in fecal samples RatesCVD432+ : Acute (11.1%) Persistent (23.9%%) Controls (9.7%) in children < 12 mo of age vs Acute (6.7%) Persistent (20.9%) Controls (12.7%) in children > 12 mo of ageThe age-stratified analyses showed that different CVD432-related genotypes were associated with persistent diarrhea in the 2 groups studied. CVD432+ strains were associated with persistent diarrhea in children <12 months of age, whereas, inchildren >12 months of age, the genotype associated with protracteddiarrhea was CVD432+EAST1+Detection of EAEC specific genotypes in fecal samples RatesCVD432+ : Acute (6.8%) Persistent (15.2%%) Controls (3.8%) in children < 12 mo of age vs Acute (3.8%) Persistent (9.3%) Controls (8.1%) in children > 12 mo of ageRatesEAST1+ : diarrhea (13%) and controls (4%) in children 6-12 mo of age vs diarrhea (8.2%) and controls (4.2%) in children < 6 mo of age ADDIN EN.CITE <EndNote><Cite><Author>Mukhopadhyay</Author><Year>2007</Year><RecNum>10960</RecNum><record><rec-number>10960</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukhopadhyay, C.</author><author>Wilson, G.</author><author>Pradhan, D.</author><author>Shivananda, P. G.</author></authors></contributors><auth-address>Department of Microbiology, Manipal College of Medical Sciences, Pokhara, Nepal. chiranjay@yahoo.co.in</auth-address><titles><title>Intestinal protozoal infestation profile in persistent diarrhea in children below age 5 years in western Nepal</title><secondary-title>Southeast Asian J Trop Med Public Health</secondary-title></titles><periodical><full-title>Southeast Asian J Trop Med Public Health</full-title></periodical><pages>13-9</pages><volume>38</volume><number>1</number><keywords><keyword>Child</keyword><keyword>Diarrhea/epidemiology/etiology/ parasitology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Nepal/epidemiology</keyword><keyword>Protozoan Infections/complications/ epidemiology</keyword></keywords><dates><year>2007</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0125-1562 (Print)&#xD;0125-1562 (Linking)</isbn><accession-num>17539240</accession-num><urls></urls></record></Cite></EndNote>Mukhopadhyay C, 2007Case-control study71 months (April 1998-March 2004)+NepalInpatientsN=508 < 5 years of age (253 children with persistent diarrhea, 155 with acute diarrhea and 100 controls)Collection of stool samplesPersistent diarrhea vs acute diarrhea vs controls*—NORates of intestinal protozoal infections in age groups (6-11; 12-23; 24-35; 36-60)Rates13.8%, 19.3%, 25.2%, and 33.2%In each age group, the rate of infection was significantly higher than the previous age group.*diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Moyo</Author><Year>2007</Year><RecNum>10881</RecNum><record><rec-number>10881</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moyo, S. J.</author><author>Maselle, S. Y.</author><author>Matee, M. I.</author><author>Langeland, N.</author><author>Mylvaganam, H.</author></authors></contributors><auth-address>Department of Microbiology and Immunology, School of Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. sabmoyo26@</auth-address><titles><title>Identification of diarrheagenic Escherichia coli isolated from infants and children in Dar es Salaam, Tanzania</title><secondary-title>BMC Infect Dis</secondary-title></titles><periodical><full-title>BMC Infect Dis</full-title></periodical><pages>92</pages><volume>7</volume><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Diarrhea, Infantile/ microbiology</keyword><keyword>Dysentery/ epidemiology/microbiology</keyword><keyword>Escherichia coli/classification/genetics/pathogenicity</keyword><keyword>Escherichia coli Infections/classification/ epidemiology</keyword><keyword>Genes, Bacterial</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Prospective Studies</keyword><keyword>Tanzania/epidemiology</keyword><keyword>Virulence Factors/genetics</keyword></keywords><dates><year>2007</year></dates><isbn>1471-2334 (Electronic)&#xD;1471-2334 (Linking)</isbn><accession-num>17688682</accession-num><urls></urls></record></Cite></EndNote>Moyo SJ, 2007Prospective cross-sectional studyDecember 2005 to February 2006.+TanzaniaInpatientsN=218 children <5yr of age, admitted for acute/persistent diarrheaDetailed clinical history and laboratory investigationsAge groups—YESDetection of EAEC strains in children with acute/persistent diarrheaRatesEAEC: 0-6mo 27.5%; 7-12mo 15.6%; 13-24 6%; 25-60mo 7.4%EAEC and EPEC were significantly more prevalent among the age group 0–6 monthsDetection of EPEC strains in children with acute/persistent diarrheaRatesEPEC: 0-6mo 13.7%; 7-12mo 3%; 13-24 3%; 25-60mo 0% ADDIN EN.CITE <EndNote><Cite><Author>Ochoa</Author><Year>2009</Year><RecNum>10049</RecNum><record><rec-number>10049</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ochoa, T. J.</author><author>Ecker, L.</author><author>Barletta, F.</author><author>Mispireta, M. L.</author><author>Gil, A. I.</author><author>Contreras, C.</author><author>Molina, M.</author><author>Amemiya, I.</author><author>Verastegui, H.</author><author>Hall, E. R.</author><author>Cleary, T. G.</author><author>Lanata, C. F.</author></authors></contributors><auth-address>Universidad Peruana Cayetano Heredia, Lima, Peru.</auth-address><titles><title>Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban areas in Lima, Peru</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>1694-702</pages><volume>49</volume><number>11</number><keywords><keyword>Age Factors</keyword><keyword>Diarrhea, Infantile/ epidemiology/ microbiology</keyword><keyword>Escherichia coli/genetics/ physiology</keyword><keyword>Escherichia coli Infections/ epidemiology/ microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Peru/epidemiology</keyword><keyword>Population Surveillance</keyword><keyword>Prevalence</keyword></keywords><dates><year>2009</year><pub-dates><date>Dec 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>19857163</accession-num><urls></urls></record></Cite></EndNote>Ochoa TJ, 2009Prospective cohort studySeptember-2006 to December-2007+PerùOutpatientsN=1034 children from 2 to 12 months of ageA field worker visited control children at home to collect stool samples. A field worker visited children with diarrhea at home at least once a week until the episode ended. Diarrhea vs not diarrhea992/1034NODuration of diarrhea in accordance to ageMean±SD7.1 ± 6.1 (children < 6mo) vs 4.9 ± 3.8 (children ≥ 6mo); p< 0.0001Persistent diarrhea was more frequent in infants < 6mo of age.**Persistent diarrheaRates13.5% (children < 6mo) vs 3.6% (children ≥ 6mo); p< 0.0001Passive surveillance diarrhea incidence, episodes/child/yearIncidence Rates1.26 (children < 6 mo) vs 0.85 (children ≥ 6mo); p=0.0018Isolation of RV in children with persistent diarrhea <6mo and ≥ 6mo of ageRates24/434 (5.9%) vs 137/530 (28.1%)*not specified how**diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Rivera</Author><Year>2010</Year><RecNum>9768</RecNum><record><rec-number>9768</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rivera, F. P.</author><author>Ochoa, T. J.</author><author>Maves, R. C.</author><author>Bernal, M.</author><author>Medina, A. M.</author><author>Meza, R.</author><author>Barletta, F.</author><author>Mercado, E.</author><author>Ecker, L.</author><author>Gil, A. I.</author><author>Hall, E. R.</author><author>Huicho, L.</author><author>Lanata, C. F.</author></authors></contributors><auth-address>Universidad Peruana Cayetano Heredia, Lima, Peru.</auth-address><titles><title>Genotypic and phenotypic characterization of enterotoxigenic Escherichia coli strains isolated from Peruvian children</title><secondary-title>J Clin Microbiol</secondary-title></titles><periodical><full-title>J Clin Microbiol</full-title></periodical><pages>3198-203</pages><volume>48</volume><number>9</number><keywords><keyword>Anti-Bacterial Agents/pharmacology</keyword><keyword>Antibodies, Bacterial/diagnostic use</keyword><keyword>Antibodies, Monoclonal/diagnostic use</keyword><keyword>Bacterial Toxins/biosynthesis/genetics</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology</keyword><keyword>Enterotoxigenic Escherichia coli/ classification/genetics/ isolation &amp;</keyword><keyword>purification/metabolism</keyword><keyword>Enterotoxins/biosynthesis/genetics</keyword><keyword>Enzyme-Linked Immunosorbent Assay/methods</keyword><keyword>Escherichia coli Infections/ microbiology</keyword><keyword>Escherichia coli Proteins/biosynthesis/genetics</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Peru</keyword><keyword>Polymerase Chain Reaction/methods</keyword><keyword>Virulence Factors/biosynthesis/genetics</keyword></keywords><dates><year>2010</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1098-660X (Electronic)&#xD;0095-1137 (Linking)</isbn><accession-num>20631096</accession-num><urls></urls></record></Cite></EndNote>Rivera FP, 2010Prospective cohort study26 months (September 2006-July 2008)+PerùOutpatientsN=1873 (1129 cases and 744 controls) children 2-24 months of ageCollection of stool samplesDiarrhea vs not diarrhea—NOClinical and epidemiological characteristics of ETEC diarrheaRatesIsolated ETEC strains in cases (3.4%) and controls 1.2%) < 12 mo of age vs cases (14.5%) and controls (8.4%) > 12 mo of ageThe incidence of ETEC diarrhea in our sample was significantly more frequent in children > 12 months of age than in younger children**diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Umamaheswari</Author><Year>2010</Year><RecNum>9702</RecNum><record><rec-number>9702</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Umamaheswari, B.</author><author>Biswal, N.</author><author>Adhisivam, B.</author><author>Parija, S. C.</author><author>Srinivasan, S.</author></authors></contributors><auth-address>Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.</auth-address><titles><title>Persistent diarrhea: risk factors and outcome</title><secondary-title>Indian J Pediatr</secondary-title></titles><periodical><full-title>Indian J Pediatr</full-title></periodical><pages>885-8</pages><volume>77</volume><number>8</number><keywords><keyword>Anemia/ complications</keyword><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Chronic Disease</keyword><keyword>Diarrhea/drug therapy/ etiology/mortality</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hyponatremia</keyword><keyword>Infant</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology</keyword><keyword>Multivariate Analysis</keyword><keyword>Odds Ratio</keyword><keyword>Prospective Studies</keyword><keyword>Respiratory Tract Infections</keyword><keyword>Risk Factors</keyword><keyword>Vitamin A Deficiency/ complications</keyword></keywords><dates><year>2010</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0973-7693 (Electronic)&#xD;0019-5456 (Linking)</isbn><accession-num>20799078</accession-num><urls></urls></record></Cite></EndNote>Umamaheswari B, 2010Case-control study17 mo, November 2000-April 2002+IndiaInpatientsN=120 children from 1 mo. to 10 yr. of age with persistent* or acute diarrheaDetailed clinical history and laboratory investigationsPersistent vs acute diarrhea55/120 - 3 monthsYESChildren with PD and AD < 1yrRatesPD 30/60(50%) vs AD 37/60 (61.7%)Persistent diarrhea was more frequent in infants <5yr of age*Children with PD and AD 1-5yrRatesPD 29/60(48.4%) vs AD 22/60 (36.7%)Children with PD and AD >5yrRatesPD 1/60(1.6%) vs AD 1/60 (1.6%)Children with PD who died (all <5yr of age)Rates5/60 (8.3%)*diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Sutra</Author><Year>2012</Year><RecNum>11938</RecNum><record><rec-number>11938</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sutra, S.</author><author>Kosuwon, P.</author><author>Chirawatkul, A.</author><author>Thepsuthammarat, K.</author></authors></contributors><auth-address>Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. sumitr@kku.ac.th</auth-address><titles><title>Burden of acute, persistent and chronic diarrhea, Thailand, 2010</title><secondary-title>J Med Assoc Thai</secondary-title></titles><periodical><full-title>J Med Assoc Thai</full-title></periodical><pages>S97-107</pages><volume>95 Suppl 7</volume><keywords><keyword>Acute Disease</keyword><keyword>Child, Hospitalized/statistics &amp; numerical data</keyword><keyword>Child, Preschool</keyword><keyword>Chronic Disease</keyword><keyword>Comorbidity</keyword><keyword>Diarrhea/ epidemiology</keyword><keyword>Dysentery/epidemiology</keyword><keyword>Female</keyword><keyword>Hospital Mortality/trends</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>International Classification of Diseases</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Seasons</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0125-2208 (Print)&#xD;0125-2208 (Linking)</isbn><accession-num>23130441</accession-num><urls></urls></record></Cite></EndNote>Sutra S, 2012Cross-sectional study2011+ThailandInpatientsChildren < 5yr of ageThe authors investigated the number of OPD visits (756,552; 1:5 ), IPD (124,403 admissions; 1:30)——YesPersistent diarrheaN° of episodes and rates202 episodes (1.6 per 1,000 admissions)age, sepsis, anemia, chronic diseases, malnutrition and HIV are related to persistent diarrheaRisk factors related to PDMultivariate analysisage, sepsis, anemia, chronic diseases, malnutrition and HIV.? ADDIN EN.CITE <EndNote><Cite><Author>Strand</Author><Year>2012</Year><RecNum>8948</RecNum><record><rec-number>8948</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Strand, T. A.</author><author>Sharma, P. R.</author><author>Gjessing, H. K.</author><author>Ulak, M.</author><author>Chandyo, R. K.</author><author>Adhikari, R. K.</author><author>Sommerfelt, H.</author></authors></contributors><auth-address>Centre for International Health, University of Bergen, Bergen, Norway. tors@</auth-address><titles><title>Risk factors for extended duration of acute diarrhea in young children</title><secondary-title>PLoS One</secondary-title></titles><periodical><full-title>PLoS One</full-title></periodical><pages>e36436</pages><volume>7</volume><number>5</number><keywords><keyword>Acute Disease</keyword><keyword>Age Factors</keyword><keyword>Breast Feeding</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ etiology/metabolism</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Nepal/epidemiology</keyword><keyword>Risk Factors</keyword><keyword>Seasons</keyword></keywords><dates><year>2012</year></dates><isbn>1932-6203 (Electronic)&#xD;1932-6203 (Linking)</isbn><accession-num>22590543</accession-num><urls></urls></record></Cite></EndNote>Strand TA, 2012Prospective cohort studyJune 1998 to September 2000+NepalOutpatientsN=335 children 6-35 mo of ageStudy physicians undertook theinitial interview and clinical examination, while trained field workers visited the homes for follow-up every fifth day until recovery—334/335—Risk of persistent diarrhea in children 6-11 mo of ageOR (95%CI)17.0 (3.5, 83.1)The odds of prolonged illness was 9.3-fold higher if a child was not breastfed, this effect was not modified by age. This is an argument for recommending breastfeeding, also beyond infancy in populations where childhood diarrhea is common.Risk of persistent diarrhea in not breast fed children OR (95%CI)9.3 (2.4, 35.7)AD= Acute diarrhea; AGE= Acute gastroenteritis; EAEC=Enteroaggregative Escherichia coli; EPEC=enteropathogenic Escherichia coli; ETEC= Enterotoxigenic Escherichia coli; NV= Norovirus; PD= Persistent diarrhea; ProD= Prolonged diarrhea; QoS=Quality of Study; RV=Rotavirus; SD=standard deviation.Table 1.2.2. Risk factor: Feeding practiceReferenceStudy typePeriod of observationQoSCountryIn/Out PatientsPopulationInterventionComparisonFU n/NITTOutcomes measuresEffect measureEffect size Comments ADDIN EN.CITE <EndNote><Cite><Author>Morales</Author><Year>2012</Year><RecNum>12390</RecNum><record><rec-number>12390</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morales, E.</author><author>Garcia-Esteban, R.</author><author>Guxens, M.</author><author>Guerra, S.</author><author>Mendez, M.</author><author>Molto-Puigmarti, C.</author><author>Lopez-Sabater, M. C.</author><author>Sunyer, J.</author></authors></contributors><auth-address>Center for Research in Environmental Epidemiology, Barcelona, Catalonia, Spain. emorales1@creal.cat</auth-address><titles><title>Effects of prolonged breastfeeding and colostrum fatty acids on allergic manifestations and infections in infancy</title><secondary-title>Clin Exp Allergy</secondary-title></titles><periodical><full-title>Clin Exp Allergy</full-title></periodical><pages>918-28</pages><volume>42</volume><number>6</number><keywords><keyword>Adult</keyword><keyword>Breast Feeding</keyword><keyword>Colostrum/ chemistry</keyword><keyword>Fatty Acids, Unsaturated/ physiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hypersensitivity/epidemiology/ etiology</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Infection/epidemiology/ etiology</keyword><keyword>Male</keyword><keyword>Odds Ratio</keyword><keyword>Pregnancy</keyword><keyword>Risk</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1365-2222 (Electronic)&#xD;0954-7894 (Linking)</isbn><accession-num>22909163</accession-num><urls></urls></record></Cite></EndNote>Morales E, 2012Population-based cohort2 years+SpainOutpatients580 children (131 never breastfed, 75 brestfed for less 2 m, 97 for 2-4m, 215 for 4-6 m, 62 for more than 6 m)Active surveillance and evaluation of risk of Wheezing, PRTIs, atopic eczema and gastroenteritis??NoIncidence of AGE from birth to 6 months and 7-14 months and incidence or recurrent AGEOR (95%CI)Risk of AGE 4-6m = 0.34 (0.18-0.64) Risk of recurrency 4-6m= 0.37 (0.17-0.77)Risk of gastroenteritis in other age ranges seems to be not significantly reduced by brestfeeding. ADDIN EN.CITE <EndNote><Cite><Author>Moore</Author><Year>2010</Year><RecNum>9760</RecNum><record><rec-number>9760</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moore, S. R.</author><author>Lima, N. L.</author><author>Soares, A. M.</author><author>Oria, R. B.</author><author>Pinkerton, R. C.</author><author>Barrett, L. J.</author><author>Guerrant, R. L.</author><author>Lima, A. A.</author></authors></contributors><auth-address>Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children&apos;s Hospital Medical Center, Cincinnati, Ohio, USA. sean.moore@</auth-address><titles><title>Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>1156-64</pages><volume>139</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Ascariasis/complications</keyword><keyword>Breast Feeding</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Diarrhea/ etiology</keyword><keyword>Female</keyword><keyword>Growth Disorders/ etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology</keyword><keyword>Proportional Hazards Models</keyword><keyword>Risk</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1528-0012 (Electronic)&#xD;0016-5085 (Linking)</isbn><accession-num>20638937</accession-num><urls></urls></record></Cite></EndNote>Moore SR, 2010Prospective cohort study127 months (August 1989-March 2000)++BrazilOutpatientsN=414 children ≤ 5 years of age and newborns between August 1989 and March 2000Nurses visit home of each newborn child 3 times a week for the first 45 mo. Then twice a week. Children with diarrhea were visited dailyDiarrhea vs not diarrhea414/414YesAge at weaning from exclusive breastfeedingLinear correlationpositive correlation with age at first ProD episode (Spearman's ρ=0.309; P=0.005)early weaning was associated with earlier onset of Prolonged diarrhea**Prolonged diarrhea= 7-13th day ADDIN EN.CITE <EndNote><Cite><Author>Morrow</Author><Year>2005</Year><RecNum>380</RecNum><record><rec-number>380</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morrow, A. L.</author><author>Ruiz-Palacios, G. M.</author><author>Jiang, X.</author><author>Newburg, D. S.</author></authors></contributors><auth-address>Center for Epidemiology and Biostatistics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children&apos;s Hospital Medical Center, OH, USA. ardythe.morrow@</auth-address><titles><title>Human-milk glycans that inhibit pathogen binding protect breast-feeding infants against infectious diarrhea</title><secondary-title>J Nutr</secondary-title></titles><periodical><full-title>J Nutr</full-title></periodical><pages>1304-7</pages><volume>135</volume><number>5</number><keywords><keyword>Breast Feeding</keyword><keyword>Diarrhea/ immunology/prevention &amp; control</keyword><keyword>Humans</keyword><keyword>Immunity, Natural</keyword><keyword>Infant</keyword><keyword>Milk, Human/ immunology</keyword><keyword>Oligosaccharides/isolation &amp; purification/pharmacology</keyword><keyword>Polysaccharides/ isolation &amp; purification/pharmacology</keyword></keywords><dates><year>2005</year><pub-dates><date>May</date></pub-dates></dates><isbn>0022-3166 (Print)</isbn><accession-num>15867329</accession-num><urls></urls></record></Cite></EndNote>Morrow AL, 2005Prospective cohort study1988–1991+USOutpatientsN=93 children up to 2yr of age and their mothersMother–infant pairs were followed from birth up to 2 y postpartum with weekly collection of infant stool and infant feedingand illness dataGroups (low, intermediate, high) of specific and total 1,2-linked milk oligosaccharides (mmol/L) 93/93YesConsumption of high levels of 2 -FL as a percentage of milk oligosaccharide (protection against Campylobacter)Poisson regressionp= 0.004Breast-feeding conveys natural anti-infective compounds tothe child and is the most effective intervention currentlyknown for preventing morbidity and mortality, caused byinfectious disease in young childrenConsumption of high levels of LDFH-I as a percentage of milk oligosaccharide (protection against Calicivirus)Poisson regressionp= 0.012Consumption of high levels of total 2-linked oligosaccharide as a percentage of milk oligosaccharide (protection against severe diarrhea)Poisson regressionp<0.0001Content of 2-linked oligosaccharides in children whocontracted ST-associated diarrhea while breast-feeding Means±SDChildren with diarrhea and ST-coli infection: 3.9 ± 0.7 SE (n = 4); children without diarrhea infected by ST-coli (7.6 ± 1.0, n= 43); uninfected controls (7.5 ± 1.0,n = 46) (P <0.01) ADDIN EN.CITE <EndNote><Cite><Author>Manger</Author><Year>2011</Year><RecNum>9174</RecNum><record><rec-number>9174</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manger, M. S.</author><author>Taneja, S.</author><author>Strand, T. A.</author><author>Ueland, P. M.</author><author>Refsum, H.</author><author>Schneede, J.</author><author>Nygard, O.</author><author>Sommerfelt, H.</author><author>Bhandari, N.</author></authors></contributors><auth-address>Institute of Medicine, University of Bergen, Bergen, Norway.</auth-address><titles><title>Poor folate status predicts persistent diarrhea in 6- to 30-month-old north Indian children</title><secondary-title>J Nutr</secondary-title></titles><periodical><full-title>J Nutr</full-title></periodical><pages>2226-32</pages><volume>141</volume><number>12</number><keywords><keyword>Biological Markers/blood</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/etiology</keyword><keyword>Female</keyword><keyword>Folic Acid/administration &amp; dosage/ blood</keyword><keyword>Folic Acid Deficiency/complications/ epidemiology</keyword><keyword>Follow-Up Studies</keyword><keyword>Homocysteine/blood</keyword><keyword>Humans</keyword><keyword>India/epidemiology</keyword><keyword>Infant</keyword><keyword>Interviews as Topic</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Treatment Outcome</keyword><keyword>Vitamin B 12/administration &amp; dosage/blood</keyword></keywords><dates><year>2011</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1541-6100 (Electronic)&#xD;0022-3166 (Linking)</isbn><accession-num>22013199</accession-num><urls></urls></record></Cite></EndNote>Manger MS, 2011Prospective cohort studyFebruary 1998-September 2000+IndiaOutpatientsN=2296 children 6-30 mo of ageDetailed clinical history and laboratory investigations—2296/2296YesRisk for PD in breast-fed childrenOR (95%CI)0.56 (0.37, 0.83) p= 0.004Breast feeding is protective against PD ADDIN EN.CITE <EndNote><Cite><Author>Allison</Author><Year>2011</Year><RecNum>9314</RecNum><record><rec-number>9314</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allison, G. M.</author><author>Rogers, K. A.</author><author>Borad, A.</author><author>Ahmed, S.</author><author>Karim, M. M.</author><author>Kane, A. V.</author><author>Hibberd, P. L.</author><author>Naumova, E. N.</author><author>Calderwood, S. B.</author><author>Ryan, E. T.</author><author>Khan, W. A.</author><author>Ward, H. D.</author></authors></contributors><auth-address>Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. gallison@</auth-address><titles><title>Antibody responses to the immunodominant Cryptosporidium gp15 antigen and gp15 polymorphisms in a case-control study of cryptosporidiosis in children in Bangladesh</title><secondary-title>Am J Trop Med Hyg</secondary-title></titles><periodical><full-title>Am J Trop Med Hyg</full-title></periodical><pages>97-104</pages><volume>85</volume><number>1</number><keywords><keyword>Animals</keyword><keyword>Antibodies, Protozoan/ biosynthesis</keyword><keyword>Antigens, Protozoan/genetics/ immunology</keyword><keyword>Bangladesh</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Cryptosporidiosis/ immunology</keyword><keyword>Cryptosporidium/ immunology</keyword><keyword>Diarrhea/ immunology/parasitology</keyword><keyword>Enzyme-Linked Immunosorbent Assay</keyword><keyword>Humans</keyword><keyword>Immunoglobulin G/biosynthesis</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Polymorphism, Genetic</keyword></keywords><dates><year>2011</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1476-1645 (Electronic)&#xD;0002-9637 (Linking)</isbn><accession-num>21734132</accession-num><urls></urls></record></Cite></EndNote>Allison GM, 2011Case-control study—+BangladeshInpatientsN=92 children from 15 days to 60 mo of age with diarrhea (46 controls with negative stool coltures for Cryptosporidium; subsequently 7 controls were found positive for PCR and were thus considered cases)Detailed clinical history and laboratory investigationsPositive for Cryptosp. vs Negative for Cryptosp.50/92 (33 cases) - 3 weeksNoN° of persistent diarrhea* (Cases vs controls)Rates37% (18/47) vs 0% (0/39)In Bangladesh, wherecryptosporidiosis is endemic, it is associated with persistent diarrhea. Although the dominant antibody response appears to be targeted to conserved peptide epitopes of g15, antibody responses to polymorphic, species- or subtype specific epitopes may also occur. These findings have implications for development of gp15 as a putative vaccine candidate*Antibody (IgG) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]68 [28; 110] vs 4 [0; 10]Antibody (IgM) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]?29 [–97; 13] vs 0 [–; 0]Antibody (IgA) levels to Cryptosporidium parvum gp15 (Initial-follow-up period)Median [25th-75th percentiles]83 [19; 243] vs 40 [3; 61]Antibody (IgG) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]62 [19; 124] vs 0 [–7; 7]Antibody (IgM) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]2 [–20; 20] vs 0 [–7; –8]Antibody (IgA) levels to Cryptosporidium hominis gp15 (Initial-follow-up period)Median [25th-75th percentiles]50 [10; 138] vs 4 [–1; 24]*diarrhea lasting > 14 days was considered persistentAGE= acute gastroenteritis; PD= Persistent diarrhea; ProD= Prolonged diarrhea; QoS=Quality of Study.Table 1.2.3. Chronic diseases and Immune deficitsReferenceStudy typePeriod of observationQoSCountryIn/Out PatientsPopulationInterventionComparisonFU n/NITTOutcomes measuresRCT nEffect measureEffect sizeComments ADDIN EN.CITE <EndNote><Cite><Author>Sugata</Author><Year>2012</Year><RecNum>12392</RecNum><record><rec-number>12392</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sugata, K.</author><author>Taniguchi, K.</author><author>Yui, A.</author><author>Nakai, H.</author><author>Asano, Y.</author><author>Hashimoto, S.</author><author>Ihira, M.</author><author>Yagasaki, H.</author><author>Takahashi, Y.</author><author>Kojima, S.</author><author>Matsumoto, K.</author><author>Kato, K.</author><author>Yoshikawa, T.</author></authors></contributors><auth-address>Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.</auth-address><titles><title>Analysis of rotavirus antigenemia in hematopoietic stem cell transplant recipients</title><secondary-title>Transpl Infect Dis</secondary-title></titles><periodical><full-title>Transpl Infect Dis</full-title></periodical><pages>49-56</pages><volume>14</volume><number>1</number><keywords><keyword>Adolescent</keyword><keyword>Antibodies, Viral/blood</keyword><keyword>Antigens, Viral/ blood</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Enzyme-Linked Immunosorbent Assay</keyword><keyword>Female</keyword><keyword>HLA Antigens/immunology</keyword><keyword>Hematopoietic Stem Cell Transplantation/ adverse effects</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Rotavirus/ immunology/isolation &amp; purification</keyword><keyword>Rotavirus Infections/blood/physiopathology/ virology</keyword><keyword>Transplantation, Homologous/adverse effects</keyword><keyword>Viremia/ immunology/virology</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1399-3062 (Electronic)&#xD;1398-2273 (Linking)</isbn><accession-num>22093089</accession-num><urls></urls></record></Cite></EndNote>Sugata K, 2012Prospective cohort studyBetween September 2004 and February 2007+/-JapanInpatientsN= 62 pediatric recipients at the time of HSCT, weekly for 3 or 4 months posttransplantCollection of recorded clinical data and serum samplesHSCT recipients vs immunocompetent RV gastroenteritis patients—NoLevels of RV antigenemia—mean number ±SD0.22 ± 0.19 vs 0.49 ± 0.18, P = 0.0011Although the duration of antigenemia was clearly longer in HSCT patients than in immunocompetent RV gastroenteritis patients, the levels of viral antigen were not as high.HLA mismatch vs matchedHLA matching OR (95%CI)9.44 (1.09–82.11) p=0.024 ADDIN EN.CITE <EndNote><Cite><Author>Pascarella</Author><Year>2009</Year><RecNum>12470</RecNum><record><rec-number>12470</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pascarella, F.</author><author>Martinelli, M.</author><author>Miele, E.</author><author>Del Pezzo, M.</author><author>Roscetto, E.</author><author>Staiano, A.</author></authors></contributors><auth-address>Department of Pediatrics, University of Naples Federico II, Naples, Italy.</auth-address><titles><title>Impact of Clostridium difficile infection on pediatric inflammatory bowel disease</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>854-8</pages><volume>154</volume><number>6</number><keywords><keyword>Adolescent</keyword><keyword>Bacterial Toxins/analysis</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Clostridium difficile</keyword><keyword>Enterocolitis, Pseudomembranous/ complications/diagnosis</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Inflammatory Bowel Diseases/diagnosis/ microbiology</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2009</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1097-6833 (Electronic)&#xD;0022-3476 (Linking)</isbn><accession-num>19230908</accession-num><urls></urls></record></Cite></EndNote>Pascarella F, 2009Retrospective, single-center, observational,case-control studybetween January 2005 andDecember 2007+/-ItalyInpatientsN= 193 patients aged 18 months to 18 years (81 affected by IBD or with an history of diarrhea and abdominal pain and 112 controls) who were admittedCollection of recorded clinical data and stool samplesIBD vs no IBD—NoPositive C difficile stool test results, n (%)—Rates20 (24.7) vs 10 (8.9) p=0.004The present study has demonstrated a higher prevalence of C difficile infection in a pediatric population with IBD compared withone without IBD. ADDIN EN.CITE <EndNote><Cite><Author>Nylund</Author><Year>2011</Year><RecNum>12469</RecNum><record><rec-number>12469</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nylund, C. M.</author><author>Goudie, A.</author><author>Garza, J. M.</author><author>Fairbrother, G.</author><author>Cohen, M. B.</author></authors></contributors><auth-address>Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. cade.nylund@usuhs.mil</auth-address><titles><title>Clostridium difficile infection in hospitalized children in the United States</title><secondary-title>Arch Pediatr Adolesc Med</secondary-title></titles><periodical><full-title>Arch Pediatr Adolesc Med</full-title></periodical><pages>451-7</pages><volume>165</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Age Distribution</keyword><keyword>Child</keyword><keyword>Child, Hospitalized/ statistics &amp; numerical data</keyword><keyword>Child, Preschool</keyword><keyword>Clostridium Infections/diagnosis/ epidemiology/therapy</keyword><keyword>Clostridium difficile/ isolation &amp; purification</keyword><keyword>Cohort Studies</keyword><keyword>Confidence Intervals</keyword><keyword>Cross Infection/diagnosis/ epidemiology</keyword><keyword>Databases, Factual</keyword><keyword>Female</keyword><keyword>Hospital Mortality/trends</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Multivariate Analysis</keyword><keyword>Odds Ratio</keyword><keyword>Retrospective Studies</keyword><keyword>Risk Assessment</keyword><keyword>Severity of Illness Index</keyword><keyword>Sex Distribution</keyword><keyword>Survival Rate</keyword><keyword>United States/epidemiology</keyword></keywords><dates><year>2011</year><pub-dates><date>May</date></pub-dates></dates><isbn>1538-3628 (Electronic)&#xD;1072-4710 (Linking)</isbn><accession-num>21199971</accession-num><urls></urls></record></Cite></EndNote>Nylund CM, 2011Retrospective cohort studyYears 1997, 2000, 2003, and 2006+USInpatientsN= 10474454 children hospitalized (0.2% cases of clostridium infection)Collection of hospital discharge data from national databaseComorbidity vs no comorbidity—NoInflammatorybowel disease—OR (95%CI)11.42 (10.16-12.83)Clostridium difficile is emerging as a major agent of severe diarrhea in children with chronic conditionsSolid organ transplant4.53 (3.92-5.24)HIV infection1.36 (1.04-1.79)Hematopoietic stem celltransplantation3.31 (2.87-3.82)Neoplastic disease3.10 (2.89-3.31)Fungal infection2.71 (2.39-3.07)Cystic fibrosis2.65 (2.22-3.17)Pancreatitis2.86 (2.41-3.39)Hematologic disorders2.50 (2.34-2.66)Gastrostomy2.00 (1.67-2.39)Liver disease2.04 (1.80-2.32)Malnutrition2.39 (2.14-2.67)Renal disease2.09 (1.99-2.19)Systemic lupuserythematosus2.06 (1.58-2.68) ADDIN EN.CITE <EndNote><Cite><Author>Bandin</Author><Year>2009</Year><RecNum>10117</RecNum><record><rec-number>10117</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bandin, F.</author><author>Kwon, T.</author><author>Linas, M. D.</author><author>Guigonis, V.</author><author>Valentin, A.</author><author>Cassaing, S.</author><author>Carol, A.</author><author>Garnier, A.</author><author>Baudouin, V.</author><author>Decramer, S.</author></authors></contributors><auth-address>Department of Paediatric Nephrology, Children&apos;s Hospital, Centre de Reference du Sud Ouest des Maladies Renales Rares, Toulouse, France.</auth-address><titles><title>Cryptosporidiosis in paediatric renal transplantation</title><secondary-title>Pediatr Nephrol</secondary-title></titles><periodical><full-title>Pediatr Nephrol</full-title></periodical><pages>2245-55</pages><volume>24</volume><number>11</number><keywords><keyword>Adolescent</keyword><keyword>Antiparasitic Agents/ therapeutic use</keyword><keyword>Biopsy</keyword><keyword>Child</keyword><keyword>Cohort Studies</keyword><keyword>Cryptosporidiosis/ drug therapy</keyword><keyword>Diarrhea/drug therapy/microbiology/virology</keyword><keyword>Drug Administration Schedule</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Immunosuppressive Agents/ therapeutic use</keyword><keyword>Kidney/surgery</keyword><keyword>Kidney Transplantation/ immunology</keyword><keyword>Male</keyword><keyword>Mycophenolic Acid/ therapeutic use</keyword><keyword>Prednisone/therapeutic use</keyword><keyword>Sirolimus/therapeutic use</keyword><keyword>Tacrolimus/therapeutic use</keyword><keyword>Thiazoles/ therapeutic use</keyword><keyword>Time Factors</keyword><keyword>Transplantation, Homologous</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1432-198X (Electronic)&#xD;0931-041X (Linking)</isbn><accession-num>19714369</accession-num><urls></urls></record></Cite></EndNote>Bandin F, 2009Retrospective case series studyJanuary 2006 to December 2008-FranceInpatientsN=199 children who received renal transplantationCollection of recorded clinical data and stool samples(1) infectious diarrhea , (2)secondary to immunosuppressant treatment (3) unclassified diarrhea.—NoEtiologic group of reported diarrheal episodes (N=64)—RatesInfectious 38/64 (59%), Immuno 14/64 (22%), Not classified 12/64 (19%)Need to have a high index of suspicion for cryptosporidiosis in pediatric renal transplant patients who present with diarrhea. The routine stool evaluations for parasites may not identify Cryptosporidium.Cryptosporidium in infectious diarrheal episodesRates7/38 (18%) ADDIN EN.CITE <EndNote><Cite><Author>Henke-Gendo</Author><Year>2009</Year><RecNum>12391</RecNum><record><rec-number>12391</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Henke-Gendo, C.</author><author>Harste, G.</author><author>Juergens-Saathoff, B.</author><author>Mattner, F.</author><author>Deppe, H.</author><author>Heim, A.</author></authors></contributors><auth-address>Institute of Virology, Medical School Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. Henke-Gendo.Cornelia@mh-hannover.de</auth-address><titles><title>New real-time PCR detects prolonged norovirus excretion in highly immunosuppressed patients and children</title><secondary-title>J Clin Microbiol</secondary-title></titles><periodical><full-title>J Clin Microbiol</full-title></periodical><pages>2855-62</pages><volume>47</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Animals</keyword><keyword>Base Sequence</keyword><keyword>Caliciviridae Infections/ diagnosis/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>DNA Primers</keyword><keyword>Feces/virology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Immunocompromised Host</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Molecular Sequence Data</keyword><keyword>Norovirus/genetics/ isolation &amp; purification</keyword><keyword>Phylogeny</keyword><keyword>Polymerase Chain Reaction/ methods</keyword><keyword>RNA, Viral/genetics</keyword><keyword>Retrospective Studies</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Sequence Alignment</keyword><keyword>Sequence Analysis, DNA</keyword><keyword>Virus Shedding</keyword><keyword>Young Adult</keyword></keywords><dates><year>2009</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1098-660X (Electronic)&#xD;0095-1137 (Linking)</isbn><accession-num>19625473</accession-num><urls></urls></record></Cite></EndNote>Henke-Gendo C, 2009Retrospective cohort study1 January 2005 to 30June 2008+GermanyInpatientsN=75 patients of all ages receiving high-level immunosuppressive drug therapy withcalcineurin inhibitorsCollection of recorded clinical data and stool samplesComparing levels of NV excretions—YesImmunosoppression as a risk factor—OR (95%CI)9.19 (2.86–29.47) p<0.0001Highly immunosuppressed patients as well as young children fail to eliminate NV infection and shed the virus at high loads for a long period of time.Transplant recipient as a risk factorOR (95%CI)7.49 (2.06–28.32) p<0.001Age < 3yr as a risk factorOR (95%CI)4.36 (1.23–15.85) p<0.008 ADDIN EN.CITE <EndNote><Cite><Author>Bok</Author><Year>2012</Year><RecNum>12393</RecNum><record><rec-number>12393</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bok, K.</author><author>Green, K. Y.</author></authors></contributors><auth-address>Caliciviruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.</auth-address><titles><title>Norovirus gastroenteritis in immunocompromised patients</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>2126-32</pages><volume>367</volume><number>22</number><keywords><keyword>Caliciviridae Infections/diagnosis/immunology/therapy</keyword><keyword>Evolution, Molecular</keyword><keyword>Gastroenteritis/diagnosis/immunology/ virology</keyword><keyword>Genotype</keyword><keyword>Humans</keyword><keyword>Immunocompetence</keyword><keyword>Immunocompromised Host</keyword><keyword>Norovirus/classification/genetics/ultrastructure</keyword></keywords><dates><year>2012</year><pub-dates><date>Nov 29</date></pub-dates></dates><isbn>1533-4406 (Electronic)&#xD;0028-4793 (Linking)</isbn><accession-num>23190223</accession-num><urls></urls></record></Cite></EndNote>Bok K, 2012Review2012+High and low income countriesInpatientsImmunocompromised patients (all ages) with persistent diarrhea————————NVs are increasingly recognized as an important cause of chronic gastroenteritis in immunocompromised patients, as reflected by the growing number of clinical case reports ADDIN EN.CITE <EndNote><Cite><Author>Kaiser</Author><Year>2012</Year><RecNum>12185</RecNum><record><rec-number>12185</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaiser, P.</author><author>Borte, M.</author><author>Zimmer, K. P.</author><author>Huppertz, H. I.</author></authors></contributors><auth-address>Prof. Hess Kinderklinik, Klinikum Bremen-Mitte, St. Juergen-Strasse, 28205 Bremen, Germany.</auth-address><titles><title>Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>337-45</pages><volume>171</volume><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hypernatremia/ etiology</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Intensive Care Units, Pediatric</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/ complications</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>21833497</accession-num><urls></urls></record></Cite></EndNote>Kaiser P, 2012Retrospective study1 October 2002 to 31 May 2008++GermanyInpatients6884 children < 5 years, 4880 RV positive and 2118 RV negative.————Underlying Cardiac disease(RV pos vs RV neg)—Number (%)32 (1.5%) vs 89 (3.2%), p<0.001The higher proportion of cardiac patients in the RV? group is due to multiple Clostridium infections in the cardiac wards in Giessen, where 56 of the 62 Clostridium infections (partially mixed infections) in the entire study group were observed (90.3%)Underlying Neurologic disease (RV pos vs RV neg)Number (%)37 (1.7%) vs 79 (2.9%), p=0.013Underlying Metabolic disease (RV pos vs RV neg)Number (%)21 (1%) vs 46 (1.7%), p=0.47 ADDIN EN.CITE <EndNote><Cite><Author>Bhutta</Author><Year>2008</Year><RecNum>10524</RecNum><record><rec-number>10524</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bhutta, Z. A.</author><author>Nelson, E. A.</author><author>Lee, W. S.</author><author>Tarr, P. I.</author><author>Zablah, R.</author><author>Phua, K. B.</author><author>Lindley, K.</author><author>Bass, D.</author><author>Phillips, A.</author></authors></contributors><auth-address>Department of Pediatrics and Child Health, the Aga Khan University and Hospital, Karachi, Pakistan.</auth-address><titles><title>Recent advances and evidence gaps in persistent diarrhea</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>260-5</pages><volume>47</volume><number>2</number><keywords><keyword>Child, Preschool</keyword><keyword>Chronic Disease</keyword><keyword>Cognition Disorders/epidemiology/etiology</keyword><keyword>Dehydration/prevention &amp; control</keyword><keyword>Diarrhea/ epidemiology/ mortality/prevention &amp; control</keyword><keyword>Growth Disorders/epidemiology/etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Micronutrients/ deficiency/therapeutic use</keyword><keyword>Research</keyword><keyword>Zinc/therapeutic use</keyword></keywords><dates><year>2008</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>18664885</accession-num><urls></urls></record></Cite></EndNote>Bhutta ZA, 2008Systematic review+Low-income countriesInpatients and OutpatientsHospitalized and not hospitalized children ≤ 5 years of age with diarrhea (Perù, Brasil, USA, Bangladesh, Haiti, England)————Increase of risf for malnutrition at 24mo of age with each diarrheal episodeBlack, Lancet 2008 (cross-sectional study in 3 World region - Asia, Africa and Latin America)OR (95%CI)4% with each diarrheal episode OR 1.04 (1.0–1.08; p < 0.03)It is not possible to determine the population-attributable fractionof stunting and undernutrition that may be related to PD—Lebenthal, New York Raven Press; 1984Prolonged small intestinal mucosa injuries has been named as a central mechanism in the pathophysiology of PD, but we must discriminatebetween persisting infective colonization with enteropathyand a postinfective enteropathy that fails to heal or heals slowly ADDIN EN.CITE <EndNote><Cite><Author>Mor</Author><Year>2009</Year><RecNum>12394</RecNum><record><rec-number>12394</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mor, S. M.</author><author>Tumwine, J. K.</author><author>Naumova, E. N.</author><author>Ndeezi, G.</author><author>Tzipori, S.</author></authors></contributors><auth-address>Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA. siobhan.mor@tufts.edu</auth-address><titles><title>Microsporidiosis and malnutrition in children with persistent diarrhea, Uganda</title><secondary-title>Emerg Infect Dis</secondary-title></titles><periodical><full-title>Emerg Infect Dis</full-title></periodical><pages>49-52</pages><volume>15</volume><number>1</number><keywords><keyword>AIDS-Related Opportunistic Infections/complications</keyword><keyword>Animals</keyword><keyword>Body Weight</keyword><keyword>Child, Preschool</keyword><keyword>Cryptosporidiosis/complications</keyword><keyword>Diarrhea/ complications/microbiology</keyword><keyword>Enterocytozoon/isolation &amp; purification/pathogenicity</keyword><keyword>Female</keyword><keyword>HIV Infections/complications</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Malnutrition/ complications</keyword><keyword>Microsporidiosis/ complications/microbiology</keyword><keyword>Nutritional Status</keyword><keyword>Regression Analysis</keyword><keyword>Uganda</keyword><keyword>Weight Loss</keyword></keywords><dates><year>2009</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1080-6059 (Electronic)&#xD;1080-6040 (Linking)</isbn><accession-num>19116049</accession-num><urls></urls></record></Cite></EndNote>Mor SM, 2009Prospective cohort studyfrom November 2002 through May 2003+UgandaInpatientsN=243 children ≤ yr of age with Persistent diarrheaCollection of recorded clinical data and stool samplesMicrosporidiosis in children with and without concurrent cryptosporidiosis and HIV224/243NoMicrosporidiosis in children with concurrent cryptosporidiosis—OR (95%CI)78.3 (30.8–199.1) p < 0.0001microsporidian fungus Enterocytozoonbieneusi is associated with lower rates of weight gainin children in Uganda with persistent diarrhea. This relationshipremained after controlling for HIV and concurrent cryptosporidiosis.Microsporidiosis in children with concurrent HIVOR (95%CI)41.8 (18.3–95.4) p<0.001Microsporidiosis in children with concurrent HIV and cryptosporidiosisOR (95%CI)153.0 (43.1–543.5) p<0.001Microsporidiosis in wasted childrenOR (95%CI)2.1 (1.2–3.7) p= 0.013Microsporidiosis in underweight childrenOR (95%CI)1.2 (0.7–2.2)p= 0.525Microsporidiosis in stunted childrenOR (95%CI)1.2 (0.7–2.2)p= 0.508 ADDIN EN.CITE <EndNote><Cite><Author>Idris</Author><Year>2010</Year><RecNum>9814</RecNum><record><rec-number>9814</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Idris, N. S.</author><author>Dwipoerwantoro, P. G.</author><author>Kurniawan, A.</author><author>Said, M.</author></authors></contributors><auth-address>Department of Child Health, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. nikmahsalamia@</auth-address><titles><title>Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response</title><secondary-title>J Infect Dev Ctries</secondary-title></titles><periodical><full-title>J Infect Dev Ctries</full-title></periodical><pages>309-17</pages><volume>4</volume><number>5</number><keywords><keyword>Blastocystis hominis/isolation &amp; purification</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Cryptosporidium/isolation &amp; purification</keyword><keyword>Diarrhea/ parasitology</keyword><keyword>Female</keyword><keyword>HIV Infections/complications</keyword><keyword>Humans</keyword><keyword>Immunocompromised Host</keyword><keyword>Infant</keyword><keyword>Intestinal Diseases, Parasitic/drug therapy/ epidemiology</keyword><keyword>Male</keyword><keyword>Metronidazole/therapeutic use</keyword><keyword>Prevalence</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2010</year><pub-dates><date>May</date></pub-dates></dates><isbn>1972-2680 (Electronic)&#xD;1972-2680 (Linking)</isbn><accession-num>20539063</accession-num><urls></urls></record></Cite></EndNote>Idris NS, 2010Prospective cross-sectional studyApril 2008 to February 2009+IndonesiaInpatientsN=42 children aged 6mo.-18 yrs , with persistent and/or recurrent diarrhea and had at least one of the following conditions: HIV infection, malignancy, severe malnutrition, on immunosuppressive therapy for a minimum of four weeks, or primary immunodeficiency.Collection of recorded clinical data and stool samplesComparing rates of intestinal parasites infections between groups38/42YesImmunocompromised state and presence of parasites infection—RatesHIV 16/42 (42%); Malignancy 4/42 (9%); Severe malnutrition (NO HIV) 3/42 (7%); Immunosuppressive therapy 1/42 (2%)The prevalence of intestinal parasitic infection among immunocompromised children with persistent and/or recurrent diarrhea was moderately high. The main groups affected were toddlers and preschoolers as well as those children infected with HIV who were not on antiretroviral therapy or with low CD4 counts. ADDIN EN.CITE <EndNote><Cite><Author>Umamaheswari</Author><Year>2010</Year><RecNum>9702</RecNum><record><rec-number>9702</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Umamaheswari, B.</author><author>Biswal, N.</author><author>Adhisivam, B.</author><author>Parija, S. C.</author><author>Srinivasan, S.</author></authors></contributors><auth-address>Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.</auth-address><titles><title>Persistent diarrhea: risk factors and outcome</title><secondary-title>Indian J Pediatr</secondary-title></titles><periodical><full-title>Indian J Pediatr</full-title></periodical><pages>885-8</pages><volume>77</volume><number>8</number><keywords><keyword>Anemia/ complications</keyword><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Chronic Disease</keyword><keyword>Diarrhea/drug therapy/ etiology/mortality</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hyponatremia</keyword><keyword>Infant</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology</keyword><keyword>Multivariate Analysis</keyword><keyword>Odds Ratio</keyword><keyword>Prospective Studies</keyword><keyword>Respiratory Tract Infections</keyword><keyword>Risk Factors</keyword><keyword>Vitamin A Deficiency/ complications</keyword></keywords><dates><year>2010</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0973-7693 (Electronic)&#xD;0019-5456 (Linking)</isbn><accession-num>20799078</accession-num><urls></urls></record></Cite></EndNote>Umamaheswari B, 2010Case-control study17 mo, November 2000-April 2002+IndiaInpatientsN=120 children from 1 mo. to 10 yr. of age with persistent or acute diarrheaDetailed clinical history and laboratory investigationsPersistent vs acute diarrhea55/120 - 3 monthsYESChildren with PD and prior antibiotic use—Rates43/60 (72.2%)Protein energy malnutrition, vitamin A deficiency and prior antibiotic use were the risk factors for PD.*OR (95%CI)5.28 (2.01–13.74) p = 0.0003Children with PD and steroid useRates8/60 (13.3%)OR (95%CI)4.46 (0.82-31.9) p = 0.048Children with PD and anemiaRates48/60 (80%)OR (95%CI)3.74 (1.55-9.15) p = 0.002Children with PD and vitamin A deficiencyRates24/60 (40%)OR (95%CI)4.28 (1.29–14.09) p = 0.012Children with PD and Z-score WFH <-2Rates35/60 (58.3%)OR (95%CI)1.66 (1.0–2.77) p = 0.04*diarrhea lasting > 14 days was considered persistent ADDIN EN.CITE <EndNote><Cite><Author>Al Jarousha</Author><Year>2011</Year><RecNum>9656</RecNum><record><rec-number>9656</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al Jarousha, A. M.</author><author>El Jarou, M. A.</author><author>El Qouqa, I. A.</author></authors></contributors><auth-address>Laboratory Medicine Department, Al Azhar University, P.O. Box 1277, Gaza, Palestine. Amoati2007@</auth-address><titles><title>Bacterial enteropathogens and risk factors associated with childhood diarrhea</title><secondary-title>Indian J Pediatr</secondary-title></titles><periodical><full-title>Indian J Pediatr</full-title></periodical><pages>165-70</pages><volume>78</volume><number>2</number><keywords><keyword>Ampicillin Resistance</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/ microbiology</keyword><keyword>Disk Diffusion Antimicrobial Tests</keyword><keyword>Enterohemorrhagic Escherichia coli/isolation &amp; purification</keyword><keyword>Escherichia coli Infections/diagnosis/epidemiology/microbiology</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/diagnosis/ epidemiology/ microbiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Malnutrition</keyword><keyword>Middle East/epidemiology</keyword><keyword>Multivariate Analysis</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2011</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0973-7693 (Electronic)&#xD;0019-5456 (Linking)</isbn><accession-num>20924718</accession-num><urls></urls></record></Cite></EndNote>Al Jarousha AM, 2011Case-control studyFebruary 2006-January 2007+PalestineInpatientsN= 465 children aged up to 12 yrs (165 controls)Detailed clinical history and laboratory investigationsDiarrhea vs not diarrhea—YesRisk for PD in malnourished childrenOR (95%CI)8.57 (3.98–18.44)p <0.001Malnutrition is a risk factor for PD ADDIN EN.CITE <EndNote><Cite><Author>Das</Author><Year>2012</Year><RecNum>8904</RecNum><record><rec-number>8904</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Das, S. K.</author><author>Faruque, A. S.</author><author>Chisti, M. J.</author><author>Malek, M. A.</author><author>Salam, M. A.</author><author>Sack, D. A.</author></authors></contributors><auth-address>International Centre for Diarrheal Disease Research, Bangladesh Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.</auth-address><titles><title>Changing trend of persistent diarrhoea in young children over two decades: observations from a large diarrhoeal disease hospital in Bangladesh</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>e452-7</pages><volume>101</volume><number>10</number><keywords><keyword>Anti-Infective Agents/administration &amp; dosage</keyword><keyword>Bangladesh/epidemiology</keyword><keyword>Breast Feeding/trends</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/microbiology</keyword><keyword>Feces/ microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Interviews as Topic</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Measles Vaccine/therapeutic use</keyword><keyword>Prevalence</keyword><keyword>Risk Assessment</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Shigella/isolation &amp; purification</keyword><keyword>Thinness/ epidemiology</keyword><keyword>Vibrio cholerae O1/isolation &amp; purification</keyword><keyword>Vitamin A/administration &amp; dosage</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>22734659</accession-num><urls></urls></record></Cite></EndNote>Das SK, 2012Case-control study1991-2010++BangladeshInpatientsN= 3776 children < 5yr of age with PD (944) and AD (2832)Detailed clinical history and laboratory investigationsPersistent vs acute diarrhea—YesChildren with PD who had wasting syndrome—OR (95%CI)(36/294) OR 1.62 (1.18, 2.21) p<0.01Malnutrition remains a risk factor for PD ADDIN EN.CITE <EndNote><Cite><Author>Sutra</Author><Year>2012</Year><RecNum>11938</RecNum><record><rec-number>11938</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sutra, S.</author><author>Kosuwon, P.</author><author>Chirawatkul, A.</author><author>Thepsuthammarat, K.</author></authors></contributors><auth-address>Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. sumitr@kku.ac.th</auth-address><titles><title>Burden of acute, persistent and chronic diarrhea, Thailand, 2010</title><secondary-title>J Med Assoc Thai</secondary-title></titles><periodical><full-title>J Med Assoc Thai</full-title></periodical><pages>S97-107</pages><volume>95 Suppl 7</volume><keywords><keyword>Acute Disease</keyword><keyword>Child, Hospitalized/statistics &amp; numerical data</keyword><keyword>Child, Preschool</keyword><keyword>Chronic Disease</keyword><keyword>Comorbidity</keyword><keyword>Diarrhea/ epidemiology</keyword><keyword>Dysentery/epidemiology</keyword><keyword>Female</keyword><keyword>Hospital Mortality/trends</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>International Classification of Diseases</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Seasons</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0125-2208 (Print)&#xD;0125-2208 (Linking)</isbn><accession-num>23130441</accession-num><urls></urls></record></Cite></EndNote>Sutra S, 2012Cross-sectional study2011+ThailandInpatientsChildren < 5yr of ageThe authors investigated the number of OPD visits (756,552; 1:5 ), IPD (124,403 admissions; 1:30)——YesPersistent diarrhea—N° of episodes and rates202 episodes (1.6 per 1,000 admissions)age, sepsis, anemia, chronic diseases, malnutrition and HIV are related to persistent diarrheaRisk factors related to PDMultivariate analysisage, sepsis, anemia, chronic diseases, malnutrition and HIV. ADDIN EN.CITE <EndNote><Cite><Author>Manger</Author><Year>2011</Year><RecNum>9174</RecNum><record><rec-number>9174</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manger, M. S.</author><author>Taneja, S.</author><author>Strand, T. A.</author><author>Ueland, P. M.</author><author>Refsum, H.</author><author>Schneede, J.</author><author>Nygard, O.</author><author>Sommerfelt, H.</author><author>Bhandari, N.</author></authors></contributors><auth-address>Institute of Medicine, University of Bergen, Bergen, Norway.</auth-address><titles><title>Poor folate status predicts persistent diarrhea in 6- to 30-month-old north Indian children</title><secondary-title>J Nutr</secondary-title></titles><periodical><full-title>J Nutr</full-title></periodical><pages>2226-32</pages><volume>141</volume><number>12</number><keywords><keyword>Biological Markers/blood</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/etiology</keyword><keyword>Female</keyword><keyword>Folic Acid/administration &amp; dosage/ blood</keyword><keyword>Folic Acid Deficiency/complications/ epidemiology</keyword><keyword>Follow-Up Studies</keyword><keyword>Homocysteine/blood</keyword><keyword>Humans</keyword><keyword>India/epidemiology</keyword><keyword>Infant</keyword><keyword>Interviews as Topic</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Treatment Outcome</keyword><keyword>Vitamin B 12/administration &amp; dosage/blood</keyword></keywords><dates><year>2011</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1541-6100 (Electronic)&#xD;0022-3166 (Linking)</isbn><accession-num>22013199</accession-num><urls></urls></record></Cite></EndNote>Manger MS, 2011Prospective cohort studyFebruary 1998-September 2000+IndiaOutpatientsN=2296 children 6-30 mo of ageDetailed clinical history and laboratory investigations—2296/2296YesRisk for PD in children with folate plasma concentrations < 25th percentile—OR (95%CI)1.77 (1.14, 2.75) p = 0.01Poor folate status was an independentpredictor of persistent diarrhea in this population HSCT=haemopoietic stem cell transplantation; IBD=Inflammatory bowel disease; NV= Norovirus; PD=Persistent diarrhea; QoS=Quality of Study; RV=Rotavirus.Table 1.3. Is there a relationship between the child’s clinical conditions and risk of severe or persistent diarrhea?ReferenceStudy typePeriod of observationQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Verrotti</Author><Year>2009</Year><RecNum>12398</RecNum><record><rec-number>12398</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Verrotti, A.</author><author>Tocco, A. M.</author><author>Coppola, G. G.</author><author>Altobelli, E.</author><author>Chiarelli, F.</author></authors></contributors><auth-address>Department of Medicine, Section of Pediatrics, University of Chieti, Ospedale Policlinico, Chieti, Italy. averrott@unich.it</auth-address><titles><title>Afebrile benign convulsions with mild gastroenteritis: a new entity?</title><secondary-title>Acta Neurol Scand</secondary-title></titles><periodical><full-title>Acta Neurol Scand</full-title></periodical><pages>73-9</pages><volume>120</volume><number>2</number><keywords><keyword>Anticonvulsants/therapeutic use</keyword><keyword>Epilepsies, Myoclonic/ complications/drug therapy</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword></keywords><dates><year>2009</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1600-0404 (Electronic)&#xD;0001-6314 (Linking)</isbn><accession-num>19432878</accession-num><urls></urls></record></Cite></EndNote>Verrotti A, 2009Systematic Review1993-2007+Japan, UK, TaiwanInpatientsN=368 children <5 yr of age with mild RV gastroenteritis_____Incidence of afebrile seizuresfollowing RV gastroenteritisRates (%)2.1–6.4%Benign afebrile seizures, not related to severe dehydration or electrolyte imbalance, have been associated with RV gastroenteritis ADDIN EN.CITE <EndNote><Cite><Author>Chan</Author><Year>2011</Year><RecNum>12306</RecNum><record><rec-number>12306</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chan, C. M.</author><author>Chan, C. W.</author><author>Ma, C. K.</author><author>Chan, H. B.</author></authors></contributors><auth-address>Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong. drvictorcmchan@</auth-address><titles><title>Norovirus as cause of benign convulsion associated with gastro-enteritis</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>373-7</pages><volume>47</volume><number>6</number><keywords><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications/ virology</keyword><keyword>Hong Kong</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Medical Audit</keyword><keyword>Norovirus/ pathogenicity</keyword><keyword>Retrospective Studies</keyword><keyword>Seizures/ etiology</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1440-1754 (Electronic)&#xD;1034-4810 (Linking)</isbn><accession-num>21309881</accession-num><urls></urls></record></Cite></EndNote>Chan CM, 2011Retrospective study+Hong-KongInpatientsN=405 children between 1mo. and 6yr of age with acute gastroenteritis (232 with RV infection and 173 with NV infection)__RV vs NV infection__Maximun body temperature (RV vs NV)Mean ± SD38.56 ± 1.01 vs 37.65 ± 0.78; p<0.001Children with RV infection had higher temperature and more diarrhea episodes, while more blood-stained stools and afebrile seizures were noted in the NV groupPresence of diarrheaRates (%)96% vs 84%; p<0.001Presence of bloody diarrheaRates (%)1% vs 5%;p=0.035C-reactive protein mg/LMean ± SD11.04 ± 18.18 vs 8.83 ± 16.96; p= 0.002Sodium mmol/LMean ± SD138.31 ± 3.20 vs 139.38 ± 2.92; p<0.001Length of stay (days)Mean ± SD3.89 ± 1.83 vs 3.60 ± 1.67; p=0.049Presence of afebrile seizureRates (%)1% vs 9%; p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Fasheh Youssef</Author><Year>2011</Year><RecNum>12128</RecNum><record><rec-number>12128</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fasheh Youssef, W.</author><author>Pino Ramirez, R.</author><author>Campistol Plana, J.</author><author>Pineda Marfa, M.</author></authors></contributors><auth-address>Pediatrics Service, University Hospital Sant Joan de Deu and Centre for Biomedical Network Research on Rare Diseases, Barcelona, Spain. wfasheh@</auth-address><titles><title>Benign afebrile convulsions in the course of mild acute gastroenteritis: a study of 28 patients and a literature review</title><secondary-title>Pediatr Emerg Care</secondary-title></titles><periodical><full-title>Pediatr Emerg Care</full-title></periodical><pages>1062-4</pages><volume>27</volume><number>11</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Comorbidity</keyword><keyword>Dehydration/epidemiology</keyword><keyword>Epilepsies, Partial/epidemiology/etiology</keyword><keyword>Epilepsy, Tonic-Clonic/epidemiology/etiology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications/epidemiology</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Male</keyword><keyword>Prognosis</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/complications/epidemiology</keyword><keyword>Salmonella Infections/complications/epidemiology</keyword><keyword>Salmonella enteritidis</keyword><keyword>Seizures/epidemiology/ etiology</keyword><keyword>Spain/epidemiology</keyword><keyword>Unnecessary Procedures</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1535-1815 (Electronic)&#xD;0749-5161 (Linking)</isbn><accession-num>22068069</accession-num><urls></urls></record></Cite></EndNote>Fasheh Youssef W, 2011Case-series_Isolation of RVNumber (%)11/28 (39)Afebrile convulsion during mild gastroenteritis is a banal symptom with good prognosisIsolation of Salmonella1/28 (4) ADDIN EN.CITE <EndNote><Cite><Author>Day</Author><Year>2012</Year><RecNum>12397</RecNum><record><rec-number>12397</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Day, T. G.</author><author>Jackson, C.</author><author>Bryant, P. A.</author></authors></contributors><auth-address>Paediatrics Department, Barnet and Chase Farm Hospitals NHS Trust, London, UK.</auth-address><titles><title>Cluster of neurological manifestations of rotavirus infection in children</title><secondary-title>BMJ Case Rep</secondary-title></titles><periodical><full-title>BMJ Case Rep</full-title></periodical><pages>20</pages><volume>2012</volume><keywords><keyword>Brain Diseases/epidemiology/ virology</keyword><keyword>Child, Preschool</keyword><keyword>Diagnosis, Differential</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Rotavirus Infections/ diagnosis/epidemiology</keyword><keyword>Seizures/virology</keyword></keywords><dates><year>2012</year></dates><isbn>1757-790X (Electronic)</isbn><accession-num>22605692</accession-num><urls></urls></record></Cite></EndNote>Day TG, 2012Case-series____First reported cluster of children presenting with neurological symptoms and stool virology positive for RV ADDIN EN.CITE <EndNote><Cite><Author>Shai</Author><Year>2013</Year><RecNum>12387</RecNum><record><rec-number>12387</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shai, S.</author><author>Perez-Becker, R.</author><author>von Konig, C. H.</author><author>von Kries, R.</author><author>Heininger, U.</author><author>Forster, J.</author><author>Huppertz, H. I.</author><author>Roos, R.</author><author>Gobel, U.</author><author>Niehues, T.</author></authors></contributors><auth-address>HELIOS Klinikum Krefeld, Zentrum fur Kinder- und Jugendmedizin, Lutherplatz 40, 47805 Krefeld, Germany. sonu.shai@helios-kliniken.de</auth-address><titles><title>Rotavirus disease in Germany--a prospective survey of very severe cases</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>e62-7</pages><volume>32</volume><number>2</number><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-0987 (Electronic)&#xD;0891-3668 (Linking)</isbn><accession-num>22914558</accession-num><urls></urls></record></Cite></EndNote>Shai S, 2013Surveillance systemBetween April 2009 and March 2011Cases of severe hypernatremia (>155mEq/L) between community-acquired gastroenteritisNumber26/84Although the incidence is relatively low comparedwith all RV cases, significant RV morbidity could be identifiedCases of severe hyponatremia (<125mEq/L) between community-acquired gastroenteritis10/84Cases of encephalopathy between community-acquired gastroenteritis58/84Cases of deaths between community-acquired gastroenteritis3/84 ADDIN EN.CITE <EndNote><Cite><Author>Shkalim</Author><Year>2012</Year><RecNum>9118</RecNum><record><rec-number>9118</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shkalim, V.</author><author>Amir, A.</author><author>Samra, Z.</author><author>Amir, J.</author></authors></contributors><auth-address>Pediatric Hematology-Oncology, Schneider Children&apos;s Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49202, Israel. shine6@walla.co.il</auth-address><titles><title>Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children</title><secondary-title>Infection</secondary-title></titles><periodical><full-title>Infection</full-title></periodical><pages>285-9</pages><volume>40</volume><number>3</number><keywords><keyword>Bacteremia/blood/epidemiology/ microbiology</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/complications/epidemiology/microbiology</keyword><keyword>Dysentery/complications/epidemiology/microbiology</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Fever/complications/epidemiology/microbiology</keyword><keyword>Gastroenteritis/blood/ complications/epidemiology/ microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Israel</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Salmonella/ isolation &amp; purification</keyword><keyword>Salmonella Infections/blood/ complications/epidemiology/ microbiology</keyword><keyword>Seasons</keyword><keyword>Seizures/complications/epidemiology/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1439-0973 (Electronic)&#xD;0300-8126 (Linking)</isbn><accession-num>22161258</accession-num><urls></urls></record></Cite></EndNote>Shkalim V, 2012Retrospective comparative study—+/-IsraelInpatients17 otherwise healthy children aged 2-36 months with non-typhoid Salmonella and bacteremia——Cases were compared to 17 age-matched children with non-typhoid salmonella gastroenteritis——Toxic appearence (cases vs controls)frequency (%)4(24%) vs 1(6%), p=0.002Toxic appearence and convulsions on admission were more common among children with non-typhoid Salmonella and bacteremia if compared to those with Salmonella AGE.Convulsions (cases vs controls)frequency (%)3(19%) vs 0, p=0.002 ADDIN EN.CITE <EndNote><Cite><Author>Payne</Author><Year>2008</Year><RecNum>10411</RecNum><record><rec-number>10411</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Payne, D. C.</author><author>Staat, M. A.</author><author>Edwards, K. M.</author><author>Szilagyi, P. G.</author><author>Gentsch, J. R.</author><author>Stockman, L. J.</author><author>Curns, A. T.</author><author>Griffin, M.</author><author>Weinberg, G. A.</author><author>Hall, C. B.</author><author>Fairbrother, G.</author><author>Alexander, J.</author><author>Parashar, U. D.</author></authors></contributors><auth-address>Epidemiology Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS-A34, Atlanta, GA 30333, USA. dvp6@</auth-address><titles><title>Active, population-based surveillance for severe rotavirus gastroenteritis in children in the United States</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>1235-43</pages><volume>122</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Age Distribution</keyword><keyword>Child, Preschool</keyword><keyword>Communicable Disease Control/methods</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/ prevention &amp; control/virology</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Population Surveillance</keyword><keyword>Risk Assessment</keyword><keyword>Rotavirus/ immunology/isolation &amp; purification</keyword><keyword>Rotavirus Infections/ epidemiology/prevention &amp; control</keyword><keyword>Rotavirus Vaccines/ administration &amp; dosage</keyword><keyword>Severity of Illness Index</keyword><keyword>Sex Distribution</keyword><keyword>United States/epidemiology</keyword><keyword>Vaccination/standards/trends</keyword></keywords><dates><year>2008</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>19047240</accession-num><urls></urls></record></Cite></EndNote>Payne DC, 2008Surveillance systemJanuary 1, 2006 to June 30, 2006+USAInpatients, ED patients and outpatients516 children (181 inpatients, 201 ED and 134 outpatients). 44% with RV diarrhea.——RV positive and RV negative patients——Frequency of vomiting (RV pos vs RV neg)frequency95% vs 79%, p<0.001Children with RV infection presented more frequently with vomiting, fever and lethargy compared to children with non RV infection.Fever (RV pos vs RV neg)frequency78% vs 63%, p=0.001Lethargy (RV pos vs RV neg)frequency53% vs 27%, p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Kaiser</Author><Year>2012</Year><RecNum>12185</RecNum><record><rec-number>12185</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaiser, P.</author><author>Borte, M.</author><author>Zimmer, K. P.</author><author>Huppertz, H. I.</author></authors></contributors><auth-address>Prof. Hess Kinderklinik, Klinikum Bremen-Mitte, St. Juergen-Strasse, 28205 Bremen, Germany.</auth-address><titles><title>Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>337-45</pages><volume>171</volume><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hypernatremia/ etiology</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Intensive Care Units, Pediatric</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/ complications</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>21833497</accession-num><urls></urls></record></Cite></EndNote>Kaiser P, 2012Retrospective study1 October 2002 to 3 May 2008+/-GermanyInpatients6884 children < 5 years, 4880 RV positive and 2118 RV negative.—————Respiratory Infections Rate (RV pos vs RV neg)Number (%)648 (30.6%) vs 1,112 (40.2%), p<0.001Hypernatremia is a specifc complication of RV positive AGEAbdominal symptoms (RV pos vs RV neg)Number (%)23 (1.1%) vs 118 (4.2%), p<0.001Neurological symptoms (RV pos vs RV neg)Number (%)50 (2.4%) vs 138 (5%), p<0.001Metabolic disorders (RV pos vs RV neg)Number (%)85 (4%) vs 56 (2%), p<0.001Hypertonic dehydrationNumber (%)49 (2.3%) vs 15 (0.5%), p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Ansaldi</Author><Year>2008</Year><RecNum>12386</RecNum><record><rec-number>12386</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ansaldi, F.</author><author>Lai, P.</author><author>Valle, L.</author><author>Riente, R.</author><author>Durando, P.</author><author>Sticchi, L.</author><author>Tucci, P.</author><author>Biasci, P.</author><author>Crovari, P.</author><author>Gasparini, R.</author><author>Icardi, G.</author></authors></contributors><auth-address>Department of Health Sciences, University of Genoa, Genoa, Italy. filippo.ansaldi@unige.it</auth-address><titles><title>Burden of rotavirus-associated and non-rotavirus-associated diarrhea among nonhospitalized individuals in central Italy: a 1-year sentinel-based epidemiological and virological surveillance</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>e51-5</pages><volume>46</volume><number>6</number><keywords><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/ virology</keyword><keyword>Gastroenteritis/epidemiology/virology</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Italy/epidemiology</keyword><keyword>Rotavirus/classification/genetics/isolation &amp; purification</keyword><keyword>Rotavirus Infections/ epidemiology/ virology</keyword><keyword>Sentinel Surveillance</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar 15</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>18260756</accession-num><urls></urls></record></Cite></EndNote>Ansaldi F, 2008Prospective Cohort studyApril 2005–April 2006+/-ItalyOutpatients3611 children < 5 years surveyed by 10 primary pediatricians; 684 with AGE——RV positive and RV negative patients——Fever (RV pos vs RV neg)frequency56.2% vs 31.8%, p<0.01Children with RV infection had significantly more fever and dehydration than RV negative patients. No difference in number of stools, blood in stools andabdominal pain.Dehydration (RV pos vs RV neg)frequency18.7% vs 9.7%, p<0.01Risk of RV AGE in patients with feverOR(95% CI)2.6 (1.8-3.7), p<0.01Risk of RV AGE in patients with dehydrationOR(95% CI)1.8 (1.1-3), p=0.02 ADDIN EN.CITE <EndNote><Cite><Author>Chisti</Author><Year>2011</Year><RecNum>9371</RecNum><record><rec-number>9371</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chisti, M. J.</author><author>Pietroni, M. A.</author><author>Smith, J. H.</author><author>Bardhan, P. K.</author><author>Salam, M. A.</author></authors></contributors><auth-address>Clinical Sciences Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh. chisti@</auth-address><titles><title>Predictors of death in under-five children with diarrhoea admitted to a critical care ward in an urban hospital in Bangladesh</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>e275-9</pages><volume>100</volume><number>12</number><keywords><keyword>Anoxia/etiology/mortality</keyword><keyword>Bangladesh/epidemiology</keyword><keyword>Child, Preschool</keyword><keyword>Comorbidity</keyword><keyword>Diarrhea/ complications/ mortality/therapy</keyword><keyword>Female</keyword><keyword>Hospitals, Urban/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Hypernatremia/etiology/mortality</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Malnutrition/etiology/mortality</keyword><keyword>Pneumonia/mortality</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Sepsis/etiology/mortality</keyword><keyword>Survival Analysis</keyword></keywords><dates><year>2011</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>21627690</accession-num><urls></urls></record></Cite></EndNote>Chisti MJ, 2011Prospective Cohort studySeptember-December 2007+/-BangladeshInpatients258 children <5yr of age admitted for severe diarrhea——Children who died vs children who survived——Absent peripheral pulse even after complete rehydrationOR(95% CI)10.9 (2.1-56.8), p < 0.01the absence of peripheral pulses even after full rehydration, severe malnutrition, hypoxaemia, lobar pneumonia and hypernatraemia are independent predictors of deathSevere malnutritionOR(95% CI)7.9 (1.8-34.8), p < 0.01HypoxaemiaOR(95% CI)8.5 (1.0-75.0), p = 0.05Radiological lobar pneumoniaOR(95% CI)17.8 (3.7-84.5), p < 0.01HypernatraemiaOR(95% CI)15.8 (3.0-81.8), p < 0.01AGE=Acute gastroenteritis; NV= Norovirus; OR=odds ratio; QoS=Quality of Study; RV=Rotavirus.1.4. Is there a relationship between setting or socio-economic factors and risk of severe or persistent diarrhea?Table 1.4.1. HospitalizationReferenceStudy typePeriod of observationQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresRCT nEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Waisbourd-Zinman</Author><Year>2011</Year><RecNum>9669</RecNum><record><rec-number>9669</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Waisbourd-Zinman, O.</author><author>Ben-Ziony, S.</author><author>Solter, E.</author><author>Chodick, G.</author><author>Ashkenazi, S.</author><author>Livni, G.</author></authors></contributors><auth-address>Department of Pediatrics A, Schneider Children&apos;s Medical Center, 14 Kaplan Street, Petach Tikva, Israel.</auth-address><titles><title>The percentage of nosocomial-related out of total hospitalizations for rotavirus gastroenteritis and its association with hand hygiene compliance</title><secondary-title>Am J Infect Control</secondary-title></titles><periodical><full-title>Am J Infect Control</full-title></periodical><pages>166-8</pages><volume>39</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Cross Infection/ epidemiology/virology</keyword><keyword>Gastroenteritis/complications/ epidemiology/virology</keyword><keyword>Hand</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hygiene</keyword><keyword>Patient Compliance</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus Infections/ epidemiology/etiology</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3296 (Electronic)&#xD;0196-6553 (Linking)</isbn><accession-num>20864220</accession-num><urls></urls></record></Cite></EndNote>Waisbourd-Zinman O, 2011Prospective Cohort studyBetween 2003 and 2006+/-IsraelInpatientsN= 2287 children RV AGE (1931 community acquired 356 Nosocomial)—Weekly surveillanceof the microbiologic laboratory for hospitalized childrenwith positive fecal RV antigenCommunity acquired vs nosocomial——Percentage of nosocomial RV AGE in children treated in full compliance with hand hygiene—CorrelationP <.0001Nosocomial cases can be easily prevented by adherence to hand hygiene measures ADDIN EN.CITE <EndNote><Cite><Author>Waisbourd-Zinman</Author><Year>2009</Year><RecNum>10359</RecNum><record><rec-number>10359</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Waisbourd-Zinman, O.</author><author>Ben-Ziony, S.</author><author>Solter, E.</author><author>Scherf, E.</author><author>Samra, Z.</author><author>Ashkenazi, S.</author></authors></contributors><auth-address>Department of Pediatrics A, Schneider Children&apos;s Medical Center, Petach Tikva 49202, Israel.</auth-address><titles><title>Hospitalizations for nosocomial rotavirus gastroenteritis in a tertiary pediatric center: a 4-year prospective study</title><secondary-title>Am J Infect Control</secondary-title></titles><periodical><full-title>Am J Infect Control</full-title></periodical><pages>465-9</pages><volume>37</volume><number>6</number><keywords><keyword>Age Factors</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross Infection/ epidemiology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Rotavirus Infections/ epidemiology/virology</keyword></keywords><dates><year>2009</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1527-3296 (Electronic)&#xD;0196-6553 (Linking)</isbn><accession-num>19155098</accession-num><urls></urls></record></Cite></EndNote>Waisbourd-Zinman O, 2009Prospective Cohort studyFrom January 1, 2003 to December 31,2006+/-IsraelInpatientsN=356 children with Nosocomial-RV AGE—Collection of clinical data———Children with Nosocomial-RV AGE ≤ 2 years—Number (%)320/356 (90%)The risk of nosocomial diarrhea is related to young age ADDIN EN.CITE <EndNote><Cite><Author>Wildi-Runge</Author><Year>2009</Year><RecNum>11906</RecNum><record><rec-number>11906</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wildi-Runge, S.</author><author>Allemann, S.</author><author>Schaad, U. B.</author><author>Heininger, U.</author></authors></contributors><auth-address>University Children&apos;s Hospital (UKBB), P.O. Box, 4005 Basel, Switzerland.</auth-address><titles><title>A 4-year study on clinical characteristics of children hospitalized with rotavirus gastroenteritis</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>1343-8</pages><volume>168</volume><number>11</number><keywords><keyword>Child, Preschool</keyword><keyword>Community-Acquired Infections/diagnosis</keyword><keyword>Cross Infection/ diagnosis/epidemiology/therapy/virology</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Gastroenteritis/ diagnosis/epidemiology/therapy/virology</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Hospitals, Pediatric</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Male</keyword><keyword>Medical Records/statistics &amp; numerical data</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/ diagnosis/epidemiology/therapy/virology</keyword><keyword>Seasons</keyword><keyword>Severity of Illness Index</keyword><keyword>Switzerland/epidemiology</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>19205732</accession-num><urls></urls></record></Cite></EndNote>Wildi-Runge S, 2009Retrospective cohort studyJanuary 2002 to March 2006+/-SwitzerlandInpatientsN=590 children <3yr of age hospitalized for RV acute gastroenteritis——Community acquired vs Nosocomial diarrhea——Persistent Diarrhea (>5days) Community (23.6%) vs Nosocomial (18%)—OR (95%CI)1.3 (0.6–3.0), p=0.46Nosocomial cases tended to be less severe than those acquired in the communityVomiting events (>2/day) Community (78%) vs Nosocomial (35%)OR (95%CI)5.3 (2.6–10.8), p< 0.001Dehydration (>5% of weight loss) Community (85%) vs Nosocomial (35%)OR (95%CI)11.3 (5.7–22.4), p <0.001 ADDIN EN.CITE <EndNote><Cite><Author>Wiegering</Author><Year>2011</Year><RecNum>11907</RecNum><record><rec-number>11907</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiegering, V.</author><author>Kaiser, J.</author><author>Tappe, D.</author><author>Weissbrich, B.</author><author>Morbach, H.</author><author>Girschick, H. J.</author></authors></contributors><auth-address>Pediatric Stem Cell Transplantation and Oncology Unit, Department of Pediatrics, University Hospital Wurzburg, Josef-Schneider-Str. 2, 97080 Wurzburg, Germany. Wiegering_V@klinik.uni-wuerzburg.de</auth-address><titles><title>Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>e401-7</pages><volume>15</volume><number>6</number><keywords><keyword>Adenoviridae/isolation &amp; purification</keyword><keyword>Adenoviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross Infection/epidemiology/microbiology/physiopathology/virology</keyword><keyword>Diarrhea/epidemiology/microbiology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/ physiopathology/virology</keyword><keyword>Germany/epidemiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Norovirus/isolation &amp; purification</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/physiopathology/virology</keyword><keyword>Salmonella Infections/epidemiology/microbiology/physiopathology</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>21489842</accession-num><urls></urls></record></Cite></EndNote>Wiegering V, 2011Retrospective cohort studyApril 1, 2005 to May 31, 2008+GermanyInpatients650 charts of children with AGE. 262 (43.8%) had RV, 188 (31.4%) NV, 58 (9.7%) Adenovirus, 47(7.9%) Salmonella.——Community acquired vs Nosocomial diarrhea——Gastroenteritis score (Community acquired vs Nosocomial infections): pulmonary symptoms—mean number ±SD 1.5±0.2 vs 3.6±0.3, p<0.001The underlying disease which led to admission, predominantly airway infections, explains the high respiratory symptoms scoreGastroenteritis score (Community acquired vs Nosocomial infections): gastrointestinal symptomsmean number ±SD13±0.1 vs 9.8±0.2 , p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Garcia-Basteiro</Author><Year>2011</Year><RecNum>11908</RecNum><record><rec-number>11908</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Garcia-Basteiro, A. L.</author><author>Bosch, A.</author><author>Sicuri, E.</author><author>Bayas, J. M.</author><author>Trilla, A.</author><author>Hayes, E. B.</author></authors></contributors><auth-address>Preventive Medicine and Epidemiology Unit, Hospital Clinic, C/Villarroel 170, CP 08036 Barcelona, Spain. basteiro@clinic.ub.es.</auth-address><titles><title>Hospitalizations due to rotavirus gastroenteritis in Catalonia, Spain, 2003-2008</title><secondary-title>BMC Res Notes</secondary-title></titles><periodical><full-title>BMC Res Notes</full-title></periodical><pages>429</pages><volume>4</volume><dates><year>2011</year></dates><isbn>1756-0500 (Electronic)&#xD;1756-0500 (Linking)</isbn><accession-num>22013948</accession-num><urls></urls></record></Cite></EndNote>Garcia-Basteiro AL, 2011Cross-sectional study2003-2008+SpainInpatientsN=3265 children < 5 years of age admitted for RV-AGE——Community acquired vs Nosocomial diarrhea——Nosocomial RV-AGE—Rates (%)892/3265 (27%)Children under 12 months old appear to be at higherrisk of acquiring nosocomial RV gastroenteritis than older childrenAnnual incidence ofpresumed nosocomial RV-AGE per 1000 hospitalizationsMean Incidence rate (95%CI)2.5 cases per 1,000 (2.0 to 2.8)Age of hospitalized children with RV-AGE (nosocomial vs community acquired) (mo)Mean ±SD5.08±9.4 vs 7.6±10.1 ADDIN EN.CITE <EndNote><Cite><Author>Gleizes</Author><Year>2006</Year><RecNum>38</RecNum><record><rec-number>38</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gleizes, O.</author><author>Desselberger, U.</author><author>Tatochenko, V.</author><author>Rodrigo, C.</author><author>Salman, N.</author><author>Mezner, Z.</author><author>Giaquinto, C.</author><author>Grimprel, E.</author></authors></contributors><auth-address>Smart Pharma Consulting, Paris, France. ogleizes@smart-</auth-address><titles><title>Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>S12-21</pages><volume>25</volume><number>1 Suppl</number><keywords><keyword>Child, Preschool</keyword><keyword>Cross Infection/economics/ epidemiology/prevention &amp;</keyword><keyword>control/therapy/transmission</keyword><keyword>Europe/epidemiology</keyword><keyword>Gastroenteritis/epidemiology/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Risk Factors</keyword><keyword>Rotavirus Infections/economics/ epidemiology/prevention &amp; control/therapy</keyword><keyword>Seasons</keyword><keyword>Vaccination</keyword></keywords><dates><year>2006</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>16397425</accession-num><urls></urls></record></Cite></EndNote>Gleizes O, 2006Review—+France, Germany, Italy, Poland, Spain and the United KingdomInpatientsChildren with a diagnosis of Nosocomial RV-AGE——Community acquired vs Nosocomial diarrhea——Nosocomial/Community acquired RV in children <5yr of age—RatioFrance: 0.61 ; Germany 1.04; Poland: 0.64; Spain: 0.96; UK: 0.76?Asymptomatic manifestations of Nosocomial RV infection in children <3mo of ageRates (%)18-39%?RV-infected health-care workers taking care of children with community-acquired RV-AGE Rates (%)76–78%The main vectors of transmission are contaminated(mostly uninfected) health care workersDuration of hospital stay (days) Nosocomial vs Community-acquired AGEMean differenceFrance: +5d; Italy: +1.7d; Poland: +5.9; Spain: +1.8; UK +4The rate of NV infection can rise to 70% if patients stay hospitalized for 6 daysAge of hospitalized children with RV-AGE (nosocomial vs community acquired) (0-5 mo)Rates (%)48% vs 20%?Age of hospitalized children with RV-AGE (nosocomial vs community acquired) (6-11 mo)Rates (%)26% vs 30%Age of hospitalized children with RV-AGE (nosocomial vs community acquired) (12-23 mo)Rates (%)19% vs 28%Age of hospitalized children with RV-AGE (nosocomial vs community acquired) (24-59 mo)Rates (%)7% vs 22%Nosocomial diarrhearequiring rehospitalizationRates (%)2 and 13% ADDIN EN.CITE <EndNote><Cite><Author>Ogilvie</Author><Year>2012</Year><RecNum>11909</RecNum><record><rec-number>11909</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ogilvie, I.</author><author>Khoury, H.</author><author>Goetghebeur, M. M.</author><author>El Khoury, A. C.</author><author>Giaquinto, C.</author></authors></contributors><auth-address>BioMedCom Consultants Inc., Montreal, QC, Canada.</auth-address><titles><title>Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review</title><secondary-title>BMC Infect Dis</secondary-title></titles><periodical><full-title>BMC Infect Dis</full-title></periodical><pages>62</pages><volume>12</volume><keywords><keyword>Child, Preschool</keyword><keyword>Community-Acquired Infections/economics/ epidemiology</keyword><keyword>Cross Infection/economics/ epidemiology</keyword><keyword>Europe/epidemiology</keyword><keyword>Gastroenteritis/economics/ epidemiology/virology</keyword><keyword>Health Care Costs/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Rotavirus Infections/economics/ epidemiology</keyword></keywords><dates><year>2012</year></dates><isbn>1471-2334 (Electronic)&#xD;1471-2334 (Linking)</isbn><accession-num>22429601</accession-num><urls></urls></record></Cite></EndNote>Ogilvie I, 2012Scoping review——Western EuropeInpatients76 studies from 16 countries on European children <5 yr of age with community-acquired and nosocomial diarrhea——Community acquired vs Nosocomial diarrhea——Patients with severe nosocomial RVGE in France, Italy, Spain and the UK2 (n=3734; n=251) Rates (%)42.6%RV gastroenteritis is a common disease associated with significant morbidity and costsacross Western EuropePatients with severe nosocomial RVGE in Austria, Germany, and SwitzerlandRates (%)24.4%, 30.2% and 40%Severe dehydration in children with community-acquired vs nosocomial gastroenteritis2 (Ireland n=663; Sweden n=984)Rates (%)80% vs 55% (Ireland) 10.8% vs 0.8% (Sweden)Mortality due to nosocomial RVGE (< vs > 12mo)1(n=10,990)Incidence rates0.74 per 100,000 vs 0.16 per 100,000 AGE= acute gastroenteritis; NV= Norovirus; OR=odds ratio; QoS=Quality of Study; RV=Rotavirus; RVGE= Rotavirus gastroenteritis.Table 1.4.2. Socioeconomic factorsReferenceStudy typePeriod of observationQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Pockett</Author><Year>2011</Year><RecNum>11910</RecNum><record><rec-number>11910</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pockett, R. D.</author><author>Adlard, N.</author><author>Carroll, S.</author><author>Rajoriya, F.</author></authors></contributors><auth-address>Epidemiologist, Cardiff Research Consortium Ltd, UK.</auth-address><titles><title>Paediatric hospital admissions for rotavirus gastroenteritis and infectious gastroenteritis of all causes in England: an analysis of correlation with deprivation</title><secondary-title>Curr Med Res Opin</secondary-title></titles><periodical><full-title>Curr Med Res Opin</full-title></periodical><pages>777-84</pages><volume>27</volume><number>4</number><keywords><keyword>Child, Preschool</keyword><keyword>Comorbidity</keyword><keyword>Diabetes Mellitus, Type 1/complications/epidemiology</keyword><keyword>England/epidemiology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/etiology</keyword><keyword>Geography</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Patient Admission/ statistics &amp; numerical data</keyword><keyword>Psychosocial Deprivation</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/complications/ epidemiology</keyword><keyword>Socioeconomic Factors</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1473-4877 (Electronic)&#xD;0300-7995 (Linking)</isbn><accession-num>21294699</accession-num><urls></urls></record></Cite></EndNote>Pockett RD, 2011Retrospective cohort study1st April 2009 and 31st March 2010+/-UKInpatientsN=1334 children ≤5 yr of age with RV-AGE——Correlation with deprivation rank——Variation of hospital admissions' rates in relation to the decrease of a deprivation rankingRates from 0.346 to 0.287 per 10,000 (p?<?0.001)Hospital admissions increased as deprivation increased**Index of Multiple Deprivation (IMD) 2007 for England ADDIN EN.CITE <EndNote><Cite><Author>Kyle</Author><Year>2011</Year><RecNum>12383</RecNum><record><rec-number>12383</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kyle, R. G.</author><author>Kukanova, M.</author><author>Campbell, M.</author><author>Wolfe, I.</author><author>Powell, P.</author><author>Callery, P.</author></authors></contributors><auth-address>Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling, Stirling, UK. richard.kyle@stir.ac.uk</auth-address><titles><title>Childhood disadvantage and emergency admission rates for common presentations in London: an exploratory analysis</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>221-6</pages><volume>96</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Age Distribution</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/epidemiology/etiology</keyword><keyword>Emergencies</keyword><keyword>Female</keyword><keyword>Fever/epidemiology/etiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Housing</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>London/epidemiology</keyword><keyword>Male</keyword><keyword>Poverty</keyword><keyword>Respiration Disorders/ epidemiology/etiology</keyword><keyword>Retrospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Urban Health/statistics &amp; numerical data</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1468-2044 (Electronic)&#xD;0003-9888 (Linking)</isbn><accession-num>20880940</accession-num><urls></urls></record></Cite></EndNote>Kyle RG, 2011Retrospective study—+UKInpatients (ED)24,481 children under 15 years admitted to ED for breathing difficulty, fever or diarrhoea during 2007/2008.—————Index of Multiple DeprivationSperman rho0.31, p=0.09There were no statistically significant relationships between the ED admission rate of children admitted for diarrhoea and the Index multiple derivation and its single indicators.overcrowding Sperman rho0.21, p=0.267houses in poor conditionSperman rho0.11, p=0.543 air qualitySperman rho0.16, p=0.387homelessnessSperman rho0.14, p=0.439AGE= acute gastroenteritis; ED=emergency department; QoS=Quality of Study; RV=Rotavirus.Table 1.4.3. Day care attendanceReferenceStudy typePeriod of observationQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresRCT nEffect measureEffect size Comments ADDIN EN.CITE <EndNote><Cite><Author>Sandora</Author><Year>2005</Year><RecNum>12385</RecNum><record><rec-number>12385</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sandora, T. J.</author><author>Taveras, E. M.</author><author>Shih, M. C.</author><author>Resnick, E. A.</author><author>Lee, G. M.</author><author>Ross-Degnan, D.</author><author>Goldmann, D. A.</author></authors></contributors><auth-address>Division of Infectious Diseases, Children&apos;s Hospital Boston, Harvard Medical School, Boston, MA, USA. thomas.sandora@childrens.harvard.edu</auth-address><titles><title>A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>587-94</pages><volume>116</volume><number>3</number><keywords><keyword>Anti-Infective Agents, Local/ administration &amp; dosage</keyword><keyword>Child Day Care Centers</keyword><keyword>Child, Preschool</keyword><keyword>Communicable Disease Control</keyword><keyword>Ethanol/ administration &amp; dosage</keyword><keyword>Family Health</keyword><keyword>Gastrointestinal Diseases/ prevention &amp; control</keyword><keyword>Hand Disinfection</keyword><keyword>Health Education</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Respiratory Tract Infections/ prevention &amp; control/transmission</keyword></keywords><dates><year>2005</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>16140697</accession-num><urls></urls></record></Cite></EndNote>Sandora TJ, 2005RCT—+USAOutpatientsN= 292 families with children aged < 5yrComputered permuted-blocks design with random block sizesSupply of alcohol-based hand sanitizer to use at home Controls281/292YesGastrointestinal-Illness transmission (treated vs controls)—IRR (95% CI)0.41 (0.19–0.90) p=.03This intervention significantly reduced the transmission of GI illnesses in the homes of families with children who were enrolled in out-of-home child care. ADDIN EN.CITE <EndNote><Cite><Author>Kotch</Author><Year>2007</Year><RecNum>10924</RecNum><record><rec-number>10924</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kotch, J. B.</author><author>Isbell, P.</author><author>Weber, D. J.</author><author>Nguyen, V.</author><author>Savage, E.</author><author>Gunn, E.</author><author>Skinner, M.</author><author>Fowlkes, S.</author><author>Virk, J.</author><author>Allen, J.</author></authors></contributors><auth-address>Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, NC, USA. jonathan_kotch@unc.edu</auth-address><titles><title>Hand-washing and diapering equipment reduces disease among children in out-of-home child care centers</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e29-36</pages><volume>120</volume><number>1</number><keywords><keyword>Child Day Care Centers</keyword><keyword>Child, Preschool</keyword><keyword>Communicable Disease Control</keyword><keyword>Diapers, Infant</keyword><keyword>Diarrhea/ prevention &amp; control</keyword><keyword>Equipment and Supplies</keyword><keyword>Food Services</keyword><keyword>Hand Disinfection</keyword><keyword>Humans</keyword><keyword>Hygiene</keyword><keyword>Infant</keyword></keywords><dates><year>2007</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>17606546</accession-num><urls></urls></record></Cite></EndNote>Kotch JB, 2007RCTSeptember 2002 to January 2003+USAOutpatientsN=388 infants and toddlers attending child-care centers (23 matched-paired centers)AppropriateInstallation of diaper-changing, hand-washing, and food-preparation equipment Controls388/388NoChild Diarrhea Frequency per 100 Child-Days (treated vs controls)—Incident rates0.90 vs 1.58 (p<0.001)High-quality equipment is associated with significantly fewer episodes of diarrhea among children and fewer sick days among staff.% of Days Child Ill per 100 Child-Days (treated vs controls)Incident rates4.0 vs 5.0 (p<0.001)% of Days Caregiver Absent because of Illness (treated vs controls)Incident rates0.77 vs 1.73 (p<0.001) ADDIN EN.CITE <EndNote><Cite><Author>Grimprel</Author><Year>2010</Year><RecNum>12384</RecNum><record><rec-number>12384</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grimprel, E.</author><author>Garbarg-Chenon, A.</author><author>Pircon, J. Y.</author><author>Curran, D.</author><author>Soriano-Gabarro, M.</author><author>Meyer, N.</author></authors></contributors><auth-address>Hopital d&apos;Enfants Armand-Trousseau, AP-HP, Paris, France. Emmanuel.Grimprel@trs.aphp.fr</auth-address><titles><title>Surveillance to estimate the burden of rotavirus gastroenteritis in children aged less than 3 years attending day care centers in Paris, France</title><secondary-title>Hum Vaccin</secondary-title></titles><periodical><full-title>Hum Vaccin</full-title></periodical><pages>399-406</pages><volume>6</volume><number>5</number><keywords><keyword>Child</keyword><keyword>Child Day Care Centers</keyword><keyword>Disease Outbreaks</keyword><keyword>Feces/virology</keyword><keyword>Gastroenteritis/economics/ epidemiology/pathology</keyword><keyword>Genotype</keyword><keyword>Health Care Costs</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Paris/epidemiology</keyword><keyword>RNA, Viral/genetics/isolation &amp; purification</keyword><keyword>Reverse Transcriptase Polymerase Chain Reaction</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Rotavirus Infections/economics/ epidemiology/pathology</keyword></keywords><dates><year>2010</year><pub-dates><date>May</date></pub-dates></dates><isbn>1554-8619 (Electronic)&#xD;1554-8600 (Linking)</isbn><accession-num>20431346</accession-num><urls></urls></record></Cite></EndNote>Grimprel E, 2010Surveillance studyDecember 2006 and May 2007+FranceOutpatientsN=371 children aged <3yr attending child-care centers————NoCases of RVGE per 100,000 person-days—Incidence rate (95%CI)46.7 (26.7-75.8)RV can easily spread in a day care setting Age-distribution of children with RV-AGERates (%)0-11 mo: 50%; 12-23mo: 37%; >24mo: 13%AGE= Acute gastroenteritis; GI=Gastrointestinal; QoS=Quality of Study; RV=Rotavirus; RVGE=Rotavirus gastroenteritis.CLINICAL EVALUATION AND DISEASE SEVERITYTable 2.1. What are the indications for a medical visit?ReferenceStudy typePeriod of observationQoSCountryIn/Out PatientsPopulationRandomizationInterventionComparisonFU n/NITTOutcomes measuresGL nEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Williams</Author><Year>2012</Year><RecNum>8816</RecNum><record><rec-number>8816</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Williams, D. J.</author><author>Edwards, K. M.</author><author>Payne, D. C.</author><author>Manning, J.</author><author>Parashar, U. D.</author><author>Lopman, B. A.</author></authors></contributors><auth-address>Division of Hospital Medicine, Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine and the Monroe Carell, Jr. Children&apos;s Hospital at Vanderbilt, Nashville, Tennessee, USA. derek.williams@vanderbilt.edu</auth-address><titles><title>Decline in gastroenteritis-related triage calls after rotavirus vaccine licensure</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e872-8</pages><volume>130</volume><number>4</number><keywords><keyword>Child, Preschool</keyword><keyword>Gastroenteritis/diagnosis/epidemiology/ prevention &amp; control/virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Licensure</keyword><keyword>Poisson Distribution</keyword><keyword>Public Health Surveillance/ methods</keyword><keyword>Regression Analysis</keyword><keyword>Rotavirus Infections/complications/diagnosis/epidemiology/ prevention &amp; control</keyword><keyword>Rotavirus Vaccines</keyword><keyword>Seasons</keyword><keyword>Telemedicine</keyword><keyword>Tennessee/epidemiology</keyword><keyword>Triage/ methods</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>22966021</accession-num><urls></urls></record></Cite></EndNote>Williams DJ, 2012Retrospective surveillance systemMay 1, 2004 to April 30, 2007May 1, 2007 to April 30, 2010+USOutpatientsN= 19731 AGE-related calls—Vanderbilt Telephone Triage ProgramPostlicensure period (2007–2010)) vs Prevaccine period (2004–2007——AGE-related Call Proportions After RV Vaccine Licensure (RV Season)—IRR (95% CI)0.72 (0.67–0.78)A telephone consultation can be appropriate in the management of uncomplicated cases of AGE ADDIN EN.CITE <EndNote><Cite><Author>van den Berg</Author><Year>2011</Year><RecNum>11902</RecNum><record><rec-number>11902</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van den Berg, J.</author><author>Berger, M. Y.</author></authors></contributors><auth-address>Department of General Practice, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.</auth-address><titles><title>Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care</title><secondary-title>BMC Fam Pract</secondary-title></titles><periodical><full-title>BMC Fam Pract</full-title></periodical><pages>134</pages><volume>12</volume><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Dehydration/diagnosis/therapy</keyword><keyword>Evidence-Based Practice</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods/ standards</keyword><keyword>Gastroenteritis/diagnosis/therapy</keyword><keyword>Guideline Adherence/standards/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Outcome and Process Assessment (Health Care)</keyword><keyword>Patient Admission/standards</keyword><keyword>Practice Guidelines as Topic/ standards</keyword><keyword>Primary Health Care/methods/standards</keyword><keyword>Referral and Consultation/standards</keyword></keywords><dates><year>2011</year></dates><isbn>1471-2296 (Electronic)&#xD;1471-2296 (Linking)</isbn><accession-num>22136388</accession-num><urls></urls></record></Cite></EndNote>van den Berg J, 2011Systematic review2011++Europe, USA, CanadaOutpatientsN=8 guidelines—Assess the quality of international CPG for the management of acute diarrhea in children in high income countries with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument———Indication to medical visit: Young agen=4Consensus (n/N) and Consistency (Y/N) of the recommendation3/4; YNot recommended by ESPGHAN, to be included*Indication to medical visit: High Output --> 6 diarrheal stool in 24 h, or > 3 vomits in 24 h or watery diarrhea > 6 times a day > 3 days (<2 years: > 1 day)Consensus (n/N) and Consistency (Y/N) of the recommendation4/4; YIndication to medical visit: Persistent vomiting or >2 vomits/24hConsensus (n/N) and Consistency (Y/N) of the recommendation3/4; YIndication to medical visit: Reported signs of severe dehydration*Consensus (n/N) and Consistency (Y/N) of the recommendation3/4; Y*Indication to medical visit: Signs of severe cause for diarrhea/underlying diseaseConsensus (n/N) and Consistency (Y/N) of the recommendation4/4; Y*Consistency of recommendations: If more than 50% of these guidelines made an identical recommendation, it was considered consistentAGE= acute gastroenteritis; CPG=Clinical practice guidelines; ESPGHAN= European Society for Paediatric Gastroenterology, Hepatology, and Nutrition; QoS=Quality of Study; RV=Rotavirus.2.2. Is there any clinical feature that may suggest a bacterial versus viral etiology of diarrhea?Table 2.2.1. Bacterial versus viralReferenceStudy typeQoSCountryIn/Out PatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Wiegering</Author><Year>2011</Year><RecNum>11907</RecNum><record><rec-number>11907</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiegering, V.</author><author>Kaiser, J.</author><author>Tappe, D.</author><author>Weissbrich, B.</author><author>Morbach, H.</author><author>Girschick, H. J.</author></authors></contributors><auth-address>Pediatric Stem Cell Transplantation and Oncology Unit, Department of Pediatrics, University Hospital Wurzburg, Josef-Schneider-Str. 2, 97080 Wurzburg, Germany. Wiegering_V@klinik.uni-wuerzburg.de</auth-address><titles><title>Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>e401-7</pages><volume>15</volume><number>6</number><keywords><keyword>Adenoviridae/isolation &amp; purification</keyword><keyword>Adenoviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross Infection/epidemiology/microbiology/physiopathology/virology</keyword><keyword>Diarrhea/epidemiology/microbiology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/ physiopathology/virology</keyword><keyword>Germany/epidemiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Norovirus/isolation &amp; purification</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/physiopathology/virology</keyword><keyword>Salmonella Infections/epidemiology/microbiology/physiopathology</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>21489842</accession-num><urls></urls></record></Cite></EndNote>Wiegering V, 2011Retrospective cohort study+GermanyInpatients650 charts of children with AGE reviewed between 2005 and 2008. 262 (43.8%) had RV, 188 (31.4%) NV, 58 (9.7%) Adenovirus, 47(7.9%) Salmonella.__Comparisons between all viral infections and Salmonella infection__Respiratory symptoms score (all viral vs Salmonella)mean score (0-6)±SD1.8±0.1 vs 0.6±0.3, p<0.001Children with viral infection had significantly more respiratory associated symptoms and vomiting, but less episodes of diarrhea and total duration of diarrhea when compared to children with Salmonella infection.Duration of diarrhea (all viral vs Salmonella)mean number ±SD3.4±0.1 vs 6.1±0.4, p<0.001Diarrhea events (all viral vs Salmonella)mean number ±SD3.8±0.1 vs 10.4±0.5, p<0.001Vomiting events (all viral vs Samonella)mean number ±SD2.6±0.2 vs 1±0.4, p<0.001Comparisons between viral infections: RV vs NV vs Adenovirus __Duration of diarrhea (RV vs NV vs AV)mean number ±SD4.1±0.2 vs 2.7±0.2 vs 3.4±0.3, p<0.001Children with RV infection had significantly higher severity scores, more diarrheal events and long-lasting diarrhea. In contrast NV infection had more vomiting events.Diarrhea events (RV vs NV vs AV)mean number ±SD4.4±0.2 vs 3.2±0.2 vs 3.4±0.4, p<0.001Vomiting events (RV vs NV vs AV)mean number ±SD2.4±0.2 vs 3.2±0.2 vs 1.6±0.3, p=0.05Gastroenteritis score (RV vs NV vs AV)mean score (0-15)±SD13.5±0.2 vs 11.9±0.2 vs 11.5±0.4, p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Payne</Author><Year>2008</Year><RecNum>10411</RecNum><record><rec-number>10411</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Payne, D. C.</author><author>Staat, M. A.</author><author>Edwards, K. M.</author><author>Szilagyi, P. G.</author><author>Gentsch, J. R.</author><author>Stockman, L. J.</author><author>Curns, A. T.</author><author>Griffin, M.</author><author>Weinberg, G. A.</author><author>Hall, C. B.</author><author>Fairbrother, G.</author><author>Alexander, J.</author><author>Parashar, U. D.</author></authors></contributors><auth-address>Epidemiology Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS-A34, Atlanta, GA 30333, USA. dvp6@</auth-address><titles><title>Active, population-based surveillance for severe rotavirus gastroenteritis in children in the United States</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>1235-43</pages><volume>122</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Age Distribution</keyword><keyword>Child, Preschool</keyword><keyword>Communicable Disease Control/methods</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/ prevention &amp; control/virology</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Population Surveillance</keyword><keyword>Risk Assessment</keyword><keyword>Rotavirus/ immunology/isolation &amp; purification</keyword><keyword>Rotavirus Infections/ epidemiology/prevention &amp; control</keyword><keyword>Rotavirus Vaccines/ administration &amp; dosage</keyword><keyword>Severity of Illness Index</keyword><keyword>Sex Distribution</keyword><keyword>United States/epidemiology</keyword><keyword>Vaccination/standards/trends</keyword></keywords><dates><year>2008</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>19047240</accession-num><urls></urls></record></Cite></EndNote>Payne DC, 2008Surveillance system +USAInpatients, ED patients and outpatients516 children (181 inpatients, 201 ED and 134 outpatients). 44% with RV diarrhea.__RV positive and RV negative patients__Fever (RV pos vs RV neg)frequency78% vs 63%, p=0.001Children with RV infection presented more frequently with vomiting, fever and lethargy compared to children with non RV infection.Lethargy (RV pos vs RV neg)frequency53% vs 27%, p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Narkeviciute</Author><Year>2008</Year><RecNum>10660</RecNum><record><rec-number>10660</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Narkeviciute, I.</author><author>Tamusauskaite, I.</author></authors></contributors><auth-address>Clinic of Children&apos;s Diseases of Vilnius University, Vilnius, Lithuania. irena.narkeviciute@vuvl.lt</auth-address><titles><title>Peculiarities of norovirus and rotavirus infections in hospitalised young children</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>289-92</pages><volume>46</volume><number>3</number><keywords><keyword>Caliciviridae Infections/diagnosis/pathology/virology</keyword><keyword>Child, Preschool</keyword><keyword>Diagnosis, Differential</keyword><keyword>Diarrhea/epidemiology/virology</keyword><keyword>Female</keyword><keyword>Fever/epidemiology/virology</keyword><keyword>Gastroenteritis/diagnosis/ pathology/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Norovirus/immunology/isolation &amp; purification</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus/immunology/isolation &amp; purification</keyword><keyword>Rotavirus Infections/diagnosis/ pathology/virology</keyword><keyword>Severity of Illness Index</keyword><keyword>Vomiting/epidemiology/virology</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>18376246</accession-num><urls></urls></record></Cite></EndNote>Narkeviciute I, 2008Retrospective study+/-LithuaniaInpatientsRandom retrospective selection of 140 charts of children < 3y with NV (70) and RV (70) infection.Random selection of charts; no allocation to any intervention_RV vs NV infection__High grade fever (BT> 38°C) (RV vs NV)frequency81% vs 48%, p<0.0001RV infection presents more likely with fever, usually high grade (>38°) and frequent diarrheal episodes (>7/d). NV AGE is commonly characterized by the presence of vomiting (71% more than 4episodes/d) and in 1/5 of cases without diarrheaFrequency of fever (RV vs NV)frequency97% vs 66%, p<0.0001Diarrhea >7 episodes/d (RV vs NV)frequency42% vs 12%, p<0.0001Vomiting > 4/d (RV vs NV)frequency49% vs 71%, p=0.01Children without diarrhea (RV vs NV)frequency4% vs 19%, p=0.01 ADDIN EN.CITE <EndNote><Cite><Author>Ansaldi</Author><Year>2008</Year><RecNum>12386</RecNum><record><rec-number>12386</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ansaldi, F.</author><author>Lai, P.</author><author>Valle, L.</author><author>Riente, R.</author><author>Durando, P.</author><author>Sticchi, L.</author><author>Tucci, P.</author><author>Biasci, P.</author><author>Crovari, P.</author><author>Gasparini, R.</author><author>Icardi, G.</author></authors></contributors><auth-address>Department of Health Sciences, University of Genoa, Genoa, Italy. filippo.ansaldi@unige.it</auth-address><titles><title>Burden of rotavirus-associated and non-rotavirus-associated diarrhea among nonhospitalized individuals in central Italy: a 1-year sentinel-based epidemiological and virological surveillance</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>e51-5</pages><volume>46</volume><number>6</number><keywords><keyword>Child, Preschool</keyword><keyword>Diarrhea/ epidemiology/ virology</keyword><keyword>Gastroenteritis/epidemiology/virology</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Italy/epidemiology</keyword><keyword>Rotavirus/classification/genetics/isolation &amp; purification</keyword><keyword>Rotavirus Infections/ epidemiology/ virology</keyword><keyword>Sentinel Surveillance</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar 15</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>18260756</accession-num><urls></urls></record></Cite></EndNote>Ansaldi F, 2008Prospective Cohort study+/-ItalyOutpatients3611 children < 5 years surveyed by 10 primary pediatricians; 684 with AGE __RV positive and RV negative patients__Fever (RV pos vs RV neg)frequency56.2% vs 31.8%, p<0.01Children with RV infection had significantly more fever and dehydration than RV negative patients. No difference in number of stools, blood in stools and abdominal pain. Dehydration (RV pos vs RV neg)frequency18.7% vs 9.7%, p<0.01Risk of RV AGE in patients with feverOR(95% CI)2.6 (1.8-3.7), p<0.01Risk of RV AGE in patients with dehydrationOR(95% CI)1.8 (1.1-3), p=0.02 ADDIN EN.CITE <EndNote><Cite><Author>Ghorashi</Author><Year>2010</Year><RecNum>9714</RecNum><record><rec-number>9714</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ghorashi, Z.</author><author>Nezami, N.</author><author>Soltani-Ahari, H.</author><author>Ghorashi, S.</author></authors></contributors><auth-address>Department of Pediatrics, Tabriz University (Medical Sciences), Eastern Azerbaijan, Iran.</auth-address><titles><title>Convulsion following gastroenteritis in children without severe electrolyte imbalance</title><secondary-title>Turk J Pediatr</secondary-title></titles><periodical><full-title>Turk J Pediatr</full-title></periodical><pages>301-5</pages><volume>52</volume><number>3</number><keywords><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Feces/microbiology</keyword><keyword>Gastroenteritis/ complications/metabolism/microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>Seizures/ etiology</keyword><keyword>Water-Electrolyte Balance</keyword></keywords><dates><year>2010</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>0041-4301 (Print)&#xD;0041-4301 (Linking)</isbn><accession-num>20718189</accession-num><urls></urls></record></Cite></EndNote>Ghorashi Z, 2010Case-control study+/-IranInpatients49 cases with convulsion due to AGE (in absence of electrolyte imbalance) and 51 controls with AGE but without convulsions_____Frequency of Shigellosis (cases vs controls)frequency8 vs 2, p=0.014The frequency of Shigellosis in the case group was significantly higher than in the control group. ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2012</Year><RecNum>8943</RecNum><record><rec-number>8943</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, S. M.</author><author>Ku, M. S.</author><author>Lee, M. Y.</author><author>Tsai, J. D.</author><author>Sheu, J. N.</author></authors></contributors><auth-address>Institute of Medicine, Chung Shan Medical University, Taiwan.</auth-address><titles><title>Diagnostic performance of serum interleukin-6 and interleukin-10 levels and clinical predictors in children with rotavirus and norovirus gastroenteritis</title><secondary-title>Cytokine</secondary-title></titles><periodical><full-title>Cytokine</full-title></periodical><pages>299-304</pages><volume>59</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/blood/diagnosis/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ blood/diagnosis/microbiology/ virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Interleukin-10/ blood</keyword><keyword>Interleukin-6/ blood</keyword><keyword>Leukocyte Count</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Norovirus/ physiology</keyword><keyword>Prognosis</keyword><keyword>ROC Curve</keyword><keyword>Rotavirus/ physiology</keyword><keyword>Rotavirus Infections/blood/diagnosis/virology</keyword><keyword>Salmonella/physiology</keyword><keyword>Salmonella Infections/blood/diagnosis/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1096-0023 (Electronic)&#xD;1043-4666 (Linking)</isbn><accession-num>22592039</accession-num><urls></urls></record></Cite></EndNote>Chen SM, 2012Prospective Cohort study+TaiwanInpatients168 children (1.2 - 4.7 years) admitted for AGE. 30 with RV, 25 NV, 26 Salmonella (SA)._____Maximum number of diarrheal episodes/d (RV vs NV vs SA)Median (IQR) RV 6(4-9.5) vs NV 4 (3-6.25) vs SA 8(6-10), p<0.001Children with Salmonellosis demonstrated higher fever, bloody diarrhea and more diarrheal episodes when compared to RV and NV positive patients.Maxiumun number of vomiting episodes/d (RV vs NV vs SA)Median (IQR) RV 4 (2-7) vs NV 2.5 (1-5.2) vs SA 1 (1-2), p<0.001Fever > 38°C (RV vs NV vs SA)Frequency (%)RV 36 (87.8%) vs NV 13 (38.2%) vs SA 29 (100%), p<0.001Maximun body temperature (RV vs NV vs SA)Median (IQR) RV 38.8 (38.4 -39) vs NV 37.9 (37.2-38.7) vs SA 39.1 (38.9-39.6), p<0.001Stool occult blood Frequency (%)RV 16 (39%) vs NV 8 (23.5%) vs SA 18 (62.1%), p<0.001 ADDIN EN.CITE <EndNote><Cite><Author>Kaiser</Author><Year>2012</Year><RecNum>12185</RecNum><record><rec-number>12185</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaiser, P.</author><author>Borte, M.</author><author>Zimmer, K. P.</author><author>Huppertz, H. I.</author></authors></contributors><auth-address>Prof. Hess Kinderklinik, Klinikum Bremen-Mitte, St. Juergen-Strasse, 28205 Bremen, Germany.</auth-address><titles><title>Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>337-45</pages><volume>171</volume><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications/virology</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hypernatremia/ etiology</keyword><keyword>Incidence</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Intensive Care Units, Pediatric</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/ complications</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>21833497</accession-num><urls></urls></record></Cite></EndNote>Kaiser P, 2012Retrospective study?GermanyInpatients6884 children < 5 years, 4880 RV positive and 2118 RV negative._____Respiratory Infections Rate (RV pos vs RV neg)Number (%) 648 (30.6%) vs 1,112 (40.2%), p<0.001Hypernatremia is a specific complication of RV positive AGEAbdominal symptoms (RV pos vs RV neg)Number (%) 23 (1.1%) vs 118 (4.2%), p<0.001Neurological symptoms (RV pos vs RV neg)Number (%) 50 (2.4%) vs 138 (5%), p<0.001Metabolic disorders (RV pos vs RV neg)Number (%) 85 (4%) vs 56 (2%), p<0.001Hypertonic dehydrationNumber (%) 49 (2.3%) vs 15 (0.5%), p<0.001AGE= acute gastroenteritis; NV=Norovirus; QoS=Quality of Study; RV=Rotavirus.Table 2.2.2. Systemic InvolvementReferenceStudy typeQoSCountryIn/Out PatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Shkalim</Author><Year>2012</Year><RecNum>9118</RecNum><record><rec-number>9118</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shkalim, V.</author><author>Amir, A.</author><author>Samra, Z.</author><author>Amir, J.</author></authors></contributors><auth-address>Pediatric Hematology-Oncology, Schneider Children&apos;s Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49202, Israel. shine6@walla.co.il</auth-address><titles><title>Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children</title><secondary-title>Infection</secondary-title></titles><periodical><full-title>Infection</full-title></periodical><pages>285-9</pages><volume>40</volume><number>3</number><keywords><keyword>Bacteremia/blood/epidemiology/ microbiology</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/complications/epidemiology/microbiology</keyword><keyword>Dysentery/complications/epidemiology/microbiology</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Fever/complications/epidemiology/microbiology</keyword><keyword>Gastroenteritis/blood/ complications/epidemiology/ microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Israel</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Salmonella/ isolation &amp; purification</keyword><keyword>Salmonella Infections/blood/ complications/epidemiology/ microbiology</keyword><keyword>Seasons</keyword><keyword>Seizures/complications/epidemiology/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1439-0973 (Electronic)&#xD;0300-8126 (Linking)</isbn><accession-num>22161258</accession-num><urls></urls></record></Cite></EndNote>Shkalim V, 2012Retrospective comparative study+/-IsraelInpatients17 otherwise healthy children aged 2-36 months with non-typhoid Salmonella and bacteremia __Cases were compared to 17 age-matched children with non-typhoid salmonella gastroenteritis __Toxic appearence (cases vs controls)frequency (%)4(24%) vs 1(6%), p=0.002Toxic appearence and convulsions on admission were more common among children with non-typhoid Salmonella and bacteremia if compared to those with Salmonella AGE.Convulsions (cases vs controls)frequency (%)3(19%) vs 0, p=0.002AGE=acute gastroenteritis; QoS=Quality of Study.2.3 How is dehydration assessed?Table 2.3.1. Clinical dehydration scaleReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Friedman</Author><Year>2004</Year><RecNum>747</RecNum><record><rec-number>747</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Friedman, J. N.</author><author>Goldman, R. D.</author><author>Srivastava, R.</author><author>Parkin, P. C.</author></authors></contributors><auth-address>Division of Pediatric Medicine, Department of Pediatrics, University of Toronto Faculty of Medicine and the Hospital for Sick Children, Toronto, Ontario, Canada.</auth-address><titles><title>Development of a clinical dehydration scale for use in children between 1 and 36 months of age</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>201-7</pages><volume>145</volume><number>2</number><keywords><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Dehydration/ diagnosis/etiology</keyword><keyword>Diagnostic Techniques, Digestive System</keyword><keyword>Female</keyword><keyword>Gastroenteritis/complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2004</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>15289767</accession-num><urls></urls></record></Cite></EndNote>Friedman JN, 2004Prospective cohort study Canada To develop a clinical dehydration scale for use in children <3 y of age. ED1371-36 mo (median: 18 mo)GE Urine output; general appearance; eyes; mucous membranes (tongue); tears; respiratory rates; heart rate. ‘Clinicians and researchers may consider this four-item, 8-point rating scale, developed using formal measurement methodology, as an alternative to scales developed ad hoc.’ ADDIN EN.CITE <EndNote><Cite><Author>Goldman</Author><Year>2008</Year><RecNum>10494</RecNum><record><rec-number>10494</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goldman, R. D.</author><author>Friedman, J. N.</author><author>Parkin, P. C.</author></authors></contributors><auth-address>Division of Pediatric Emergency Medicine, BC Children&apos;s Hospital, 4480 Oak St, Vancouver, BC V6H 3V4, Canada. rgoldman@cw.bc.ca</auth-address><titles><title>Validation of the clinical dehydration scale for children with acute gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>545-9</pages><volume>122</volume><number>3</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Diagnostic Techniques, Digestive System/ standards</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/ complications/diagnosis</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>Reproducibility of Results</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2008</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>18762524</accession-num><urls></urls></record></Cite></EndNote>Goldman RD, 2008Prospective cohort study Canada To validate the CDS with a new cohort of patients with AGE. Tertiary care ED205 1 mo -5 y (22.4 ± 14.9 mo) Symptoms of AGE Length of stay, proportion of children receiving intravenous rehydration; proportion of children with abnormal serum pH values or bicarbonate levels. The CDS was valuable in predicting a longer length of stay and the need for intravenous rehydration in children with symptoms of AGE. ADDIN EN.CITE <EndNote><Cite><Author>Bailey</Author><Year>2010</Year><RecNum>9770</RecNum><record><rec-number>9770</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bailey, B.</author><author>Gravel, J.</author><author>Goldman, R. D.</author><author>Friedman, J. N.</author><author>Parkin, P. C.</author></authors></contributors><auth-address>Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. benoit.bailey@umontreal.ca</auth-address><titles><title>External validation of the clinical dehydration scale for children with acute gastroenteritis</title><secondary-title>Acad Emerg Med</secondary-title></titles><periodical><full-title>Acad Emerg Med</full-title></periodical><pages>583-8</pages><volume>17</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/ etiology/therapy</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2010</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1553-2712 (Electronic)&#xD;1069-6563 (Linking)</isbn><accession-num>20624137</accession-num><urls></urls></record></Cite></EndNote>Bailey B, 2010Prospective cohort study Canada To validate the CDS for children with gastroenteritis in a different ED from where it was initially derived and validated. Tertiary care ED 150 1 mo – 5 y Vomiting and/or diarrhea Primary: the association between the CDS for children and the length of stay in ED after being seen by the attending physician. The CDS is a good predictor of (1) length of stay in the ED after being seen by a physician; (2) perceived need for IV rehydration; (3) utilization of laboratory blood tests. ADDIN EN.CITE <EndNote><Cite><Author>Gravel</Author><Year>2010</Year><RecNum>9648</RecNum><record><rec-number>9648</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gravel, J.</author><author>Manzano, S.</author><author>Guimont, C.</author><author>Lacroix, L.</author><author>Gervaix, A.</author><author>Bailey, B.</author></authors></contributors><auth-address>Departement de pediatrie, CHU Sainte-Justine, chemin Cote-Sainte-Catherine, Montreal, Quebec, Canada. graveljocelyn@</auth-address><titles><title>[Multicenter validation of the clinical dehydration scale for children]</title><secondary-title>Arch Pediatr</secondary-title></titles><periodical><full-title>Arch Pediatr</full-title></periodical><pages>1645-51</pages><volume>17</volume><number>12</number><keywords><keyword>Body Weight</keyword><keyword>Chi-Square Distribution</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/complications/ diagnosis/ etiology/therapy</keyword><keyword>Diarrhea/complications/etiology</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Physical Examination</keyword><keyword>Prospective Studies</keyword><keyword>Quebec</keyword><keyword>Reproducibility of Results</keyword><keyword>Sampling Studies</keyword><keyword>Severity of Illness Index</keyword><keyword>Switzerland</keyword><keyword>Treatment Outcome</keyword><keyword>Vomiting/complications/etiology</keyword><keyword>Weight Gain</keyword></keywords><dates><year>2010</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1769-664X (Electronic)&#xD;0929-693X (Linking)</isbn><accession-num>20951010</accession-num><urls></urls></record></Cite></EndNote>Gravel J, 2010Prospective cohort study Switzerland, Canada To validate the association between the CDS and markers of dehydration in children aged 1 mo to 5 y visiting ED for vomiting and/or diarrhea. ED2191 mo -5 y (mean age: 22 ± 14 mo; range 4 mo to 4 y) Vomiting and/or diarrhea Primary: the percentage of dehydration calculated by the difference in weight at first evaluation and after recovery. Secondary: proportion of blood test measurements, intravenous use, hospitalization, and inter-rater agreement. ‘CDS categories correlate well with markers of dehydration four young children complaining of vomiting and/or diarrhea in the ED.’ ADDIN EN.CITE <EndNote><Cite><Author>Kinlin</Author><Year>2012</Year><RecNum>12033</RecNum><record><rec-number>12033</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kinlin, L. M.</author><author>Freedman, S. B.</author></authors></contributors><auth-address>Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.</auth-address><titles><title>Evaluation of a clinical dehydration scale in children requiring intravenous rehydration</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e1211-9</pages><volume>129</volume><number>5</number><keywords><keyword>Bicarbonates/blood</keyword><keyword>Body Weight</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Dehydration/ classification/diagnosis/ therapy</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Observer Variation</keyword><keyword>Reproducibility of Results</keyword><keyword>Severity of Illness Index</keyword><keyword>Statistics as Topic</keyword></keywords><dates><year>2012</year><pub-dates><date>May</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>22529270</accession-num><urls></urls></record></Cite></EndNote>Kinlin LM, 2012Prospective cohort study Canada To evaluate the reliability and validity of the CDS in a cohort of children with gastroenteritis and evidence of dehydration. Tertiary ED226 ≥3 mo GE and dehydration requiring intravenous rehydration Reliablity (by comparing the scores assigned independently by a trained research nurse and a physician). Validity (by using parameters reflective of disease severity: weight gain; baseline laboratory results; willingness of the physician to discharge the patient; hospitalization; length of stay). ‘In children administered intravenous rehydration, the CDS was characterized by moderate interobserver reliability and weak associations with objective measures of disease severity. These data do not support its use as a tool to dictate the need for intravenous rehydration or to predict clinical course.’ ADDIN EN.CITE <EndNote><Cite><Author>Pringle</Author><Year>2011</Year><RecNum>12450</RecNum><record><rec-number>12450</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pringle, K.</author><author>Shah, S. P.</author><author>Umulisa, I.</author><author>Mark Munyaneza, R. B.</author><author>Dushimiyimana, J. M.</author><author>Stegmann, K.</author><author>Musavuli, J.</author><author>Ngabitsinze, P.</author><author>Stulac, S.</author><author>Levine, A. C.</author></authors></contributors><auth-address>Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA. Kimberly.pringle@brown.edu.</auth-address><titles><title>Comparing the accuracy of the three popular clinical dehydration scales in children with diarrhea</title><secondary-title>Int J Emerg Med</secondary-title></titles><periodical><full-title>Int J Emerg Med</full-title></periodical><pages>58</pages><volume>4</volume><dates><year>2011</year></dates><isbn>1865-1380 (Electronic)</isbn><accession-num>21902838</accession-num><urls></urls></record></Cite></EndNote>Pringle K, 2011Prospective cohort study RwandaTo determine whether the WHO scale, the Gorelick scale and the CDS scales can accurately assess dehydration status in children when performed by nurses or GP in a low-income country. Hospital49 <15 y (but analysis limited to children fitting within the predefined age ranges for each of the scales) Diarrhea and/or vomiting Sensitivity; specificity. ‘In this sample of children, the WHO scale, Gorelick scale, and CDS did not provide an accurate assessment of dehydration status when used by GP and nurses in a developing world setting’. ADDIN EN.CITE <EndNote><Cite><Author>Pruvost</Author><Year>2013</Year><RecNum>12449</RecNum><record><rec-number>12449</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pruvost, I.</author><author>Dubos, F.</author><author>Chazard, E.</author><author>Hue, V.</author><author>Duhamel, A.</author><author>Martinot, A.</author></authors></contributors><auth-address>Univ Lille Nord de France, UDSL, Lille, France.</auth-address><titles><title>The value of body weight measurement to assess dehydration in children</title><secondary-title>PLoS One</secondary-title></titles><periodical><full-title>PLoS One</full-title></periodical><pages>e55063</pages><volume>8</volume><number>1</number><keywords><keyword>Body Weight</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/ physiopathology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Reference Values</keyword><keyword>Weight Gain</keyword></keywords><dates><year>2013</year></dates><isbn>1932-6203 (Electronic)&#xD;1932-6203 (Linking)</isbn><accession-num>23383058</accession-num><urls></urls></record></Cite></EndNote>Pruvost I, 2013Prospective cohort study FranceTo estimate the value of post-illness weight gain prospectively as a gold standard for acute weight lossin a larger population.Tertiary ED2931 to 24 months of age Acute diarrhea, and daily weightsurveillance for 7 days following the ED visit, were includedPearson correlation between post-illness and theoretical weightThe correlation between post-illness and theoretical weight was excellent (0.978), butbootstrapped linear regression analysis showed that post-illness weight underestimated theoretical weight by 0.48 kg. These data suggest that post-illness weight is of little value as a gold standard to determine the true level of dehydrationCDS=clinical dehydration scale; ED=emergency department; WHO=World Health Organization.Table 2.3.2. Severity scoresReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Schnadower</Author><Year>2013</Year><RecNum>12448</RecNum><record><rec-number>12448</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schnadower, D.</author><author>Tarr, P. I.</author><author>Gorelick, M. H.</author><author>O&apos;Connell, K.</author><author>Roskind, C. G.</author><author>Powell, E. C.</author><author>Rao, J.</author><author>Bhatt, S.</author><author>Freedman, S. B.</author></authors></contributors><auth-address>*Division of Pediatric Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis MO daggerDivision of Gastroenterology, Hepatology, and Nutrition, Washington University School of Medicine in St. Louis, St. Louis, MO double daggerDivision of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI section signDivision of Pediatric Emergency Medicine, Children&apos;s National Medical Center, Washington DC ||Division of Pediatric Emergency Medicine, Columbia University College of Physician and Surgeons, New York, NY paragraph signDivision of Pediatric Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL #Division of Pediatric Emergency Medicine, Wayne State School of Medicine, Detroit, MI **Division of Pediatric Emergency Medicine, Cincinnati Children&apos;s Hospital, Cincinnati, OH daggerdaggerSections of Paediatric Emergency Medicine and Gastroenterology, Alberta Children&apos;s Hospital, Alberta Children&apos;s Hospital Research Institute, University of Calgary, Calgary, AB.</auth-address><titles><title>Validation of the Modified Vesikari Score in Children with Gastroenteritis in 5 U.S. Emergency Departments</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>514-9</pages><volume>57</volume><dates><year>2013</year><pub-dates><date>May 14</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>23676445</accession-num><urls></urls></record></Cite></EndNote>Schnadower D, 2013Prospective cohort study US To evaluate the reliability, construct validity, and generalizabilityof the Modified Vesikari Score by studying its characteristics in a network of pediatricEDs in the United States ED282Between 91 days and 48 months of age)AGE Reliability, construct validity, and generalizabilityof the Modified Vesikari Score‘The Modified Vesikari Score effectively measures global severity of disease andperforms similarly in varying populations within the US health care system. Its characteristics support its use in multisite outpatient clinical trials.’ ADDIN EN.CITE <EndNote><Cite><Author>Ruuska</Author><Year>1990</Year><RecNum>5306</RecNum><record><rec-number>5306</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ruuska, T.</author><author>Vesikari, T.</author></authors></contributors><auth-address>Department of Paediatrics, Tampere University Central Hospital, Finland.</auth-address><titles><title>Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes</title><secondary-title>Scand J Infect Dis</secondary-title></titles><periodical><full-title>Scand J Infect Dis</full-title></periodical><pages>259-67</pages><volume>22</volume><number>3</number><keywords><keyword>Cohort Studies</keyword><keyword>Diarrhea, Infantile</keyword><keyword>Double-Blind Method</keyword><keyword>Enzyme-Linked Immunosorbent Assay</keyword><keyword>Feces/microbiology</keyword><keyword>Finland</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis</keyword><keyword>Humans</keyword><keyword>Infant, Newborn</keyword><keyword>Longitudinal Studies</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus Infections</keyword></keywords><dates><year>1990</year></dates><isbn>0036-5548 (Print)</isbn><accession-num>2371542</accession-num><urls></urls></record></Cite></EndNote>Ruuska T, 1990Prospective cohort study FinlandTo assess the use of the classical Vesikari score for clinical severity of diarrhoeal episodes Hospital336 24-32 months of ageAGE Severity of symptoms between RV e non-RV AGE Using this system, the mean severity score for the 65 episodes of RV diarrhoea was 11.0 +/- 3.7 as compared to 5.6 +/- 3.2 for the 183 episodes of non-RV diarrhoea (p<0.001). AGE= acute gastroenteritis; ED=emergency department; RV=Rotavirus.Table 2.3.3. Clinical and laboratory assessmentReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Parkin</Author><Year>2010</Year><RecNum>12495</RecNum><record><rec-number>12495</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parkin, P. C.</author><author>Macarthur, C.</author><author>Khambalia, A.</author><author>Goldman, R. D.</author><author>Friedman, J. N.</author></authors></contributors><auth-address>Division of Pediatric Medicine and the Pediatric Outcomes Research Team, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. patricia.parkin@sickkids.ca</auth-address><titles><title>Clinical and laboratory assessment of dehydration severity in children with acute gastroenteritis</title><secondary-title>Clin Pediatr (Phila)</secondary-title></titles><periodical><full-title>Clin Pediatr (Phila)</full-title></periodical><pages>235-9</pages><volume>49</volume><number>3</number><keywords><keyword>Acute Disease</keyword><keyword>Bicarbonates/ blood</keyword><keyword>Body Weight</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ blood/etiology/ physiopathology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/complications/ diagnosis</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Odds Ratio</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>Severity of Illness Index</keyword><keyword>Water-Electrolyte Imbalance/blood/ diagnosis/etiology</keyword></keywords><dates><year>2010</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1938-2707 (Electronic)&#xD;0009-9228 (Linking)</isbn><accession-num>19487761</accession-num><urls></urls></record></Cite></EndNote>Parkin PC, 2010Data werecollected prospectively; however the analysis was post hoc.Canada To evaluate clinical and laboratory assessment (serum bicarbonate and venous pH) of dehydration severity in children. ED931-36 mo AGEFor a clinical score of 0, the LR+ 2.2 (0.9-5.3); For a clinical score of 1 to 4, the LR+ was 1.3 (0.90-1.74); For a clinical score of 5 to 8, the LR+ was 5.2 (2.2-12.8); For a venous pH <7.32, the LR+ was 7.2 (2.4-21.9); For serum bicarbonate <18 mmol/L, the LR+ was 11.6 (3.5-38.0).Clinicians may find it useful to incorporate the Clinical Dehydration Scale and laboratory measures into clinical decision-making algorithms to assess dehydration severity in children with acute gastroenteritis.AGE= acute gastroenteritis; ED=emergency department; LR=likelihood ratio.Table 2.3.4. Standardized Scoring SystemReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Roland</Author><Year>2010</Year><RecNum>9947</RecNum><record><rec-number>9947</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roland, D.</author><author>Clarke, C.</author><author>Borland, M. L.</author><author>Pascoe, E. M.</author></authors></contributors><auth-address>Emergency Department, Leicester Royal Infirmary, Leicester, UK. damos@.uk</auth-address><titles><title>Does a standardised scoring system of clinical signs reduce variability between doctors&apos; assessments of the potentially dehydrated child?</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>103-7</pages><volume>46</volume><number>3</number><keywords><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology</keyword><keyword>Diagnostic Errors/ prevention &amp; control</keyword><keyword>Female</keyword><keyword>Gastroenteritis/complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Internship and Residency</keyword><keyword>Male</keyword><keyword>Medical Staff, Hospital</keyword><keyword>Observer Variation</keyword><keyword>Pediatrics/education</keyword><keyword>Physical Examination/ standards</keyword><keyword>Reference Standards</keyword><keyword>Regression Analysis</keyword><keyword>Reproducibility of Results</keyword><keyword>Severity of Illness Index</keyword><keyword>Western Australia</keyword></keywords><dates><year>2010</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1440-1754 (Electronic)&#xD;1034-4810 (Linking)</isbn><accession-num>20105256</accession-num><urls></urls></record></Cite></EndNote>Roland D, 2010Prospective observational studyAustralia To determine if scoring system based on standardized clinical signs would reduce the variability between doctors’ assessment of dehydration. ED 1001 mo-12 y (median 24 mo)GEEstimated percentage dehydration. Agreement between raters. The clinical scoring system used did not reduce the variability of assessment of dehydrationED=emergency department; GE=gastroenteritis.Table 2.3.5. UltrasoundReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2007</Year><RecNum>12451</RecNum><record><rec-number>12451</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, L.</author><author>Kim, Y.</author><author>Santucci, K. A.</author></authors></contributors><auth-address>Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. lei.chen@yale.edu</auth-address><titles><title>Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration</title><secondary-title>Acad Emerg Med</secondary-title></titles><periodical><full-title>Acad Emerg Med</full-title></periodical><pages>841-5</pages><volume>14</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Aorta/ultrasonography</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology/therapy</keyword><keyword>Female</keyword><keyword>Gastrointestinal Diseases/complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Organ Size</keyword><keyword>Point-of-Care Systems</keyword><keyword>Prospective Studies</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Sodium Chloride/administration &amp; dosage</keyword><keyword>Vena Cava, Inferior/ ultrasonography</keyword></keywords><dates><year>2007</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1553-2712 (Electronic)&#xD;1069-6563 (Linking)</isbn><accession-num>17898246</accession-num><urls></urls></record></Cite></EndNote>Chen L, 2007Prospective observational study USTo compare the IVC and Ao diameters ratio of dehydrated children with controls and to compare the IVC/Ao ratio before and after IV rehydration in children with dehydration. ED726 mo-16 ySubjects with evidence of dehydration plus matched controls IVC/Ao ratioThe ratio of inferior vena cava diameter is lower in children with clinical dehydration. It increases with administration of IV fluid boluses. ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2010</Year><RecNum>9626</RecNum><record><rec-number>9626</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, L.</author><author>Hsiao, A.</author><author>Langhan, M.</author><author>Riera, A.</author><author>Santucci, K. A.</author></authors></contributors><auth-address>Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. lei.chen@yale.edu</auth-address><titles><title>Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis</title><secondary-title>Acad Emerg Med</secondary-title></titles><periodical><full-title>Acad Emerg Med</full-title></periodical><pages>1042-7</pages><volume>17</volume><number>10</number><keywords><keyword>Aorta/ ultrasonography</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Dehydration/etiology/therapy/ ultrasonography</keyword><keyword>Diarrhea/complications/diagnosis</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Gastroenteritis/ complications/diagnosis</keyword><keyword>Hemodynamics/physiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Linear Models</keyword><keyword>Male</keyword><keyword>Observer Variation</keyword><keyword>Pilot Projects</keyword><keyword>Point-of-Care Systems</keyword><keyword>Prospective Studies</keyword><keyword>Reproducibility of Results</keyword><keyword>Severity of Illness Index</keyword><keyword>Ultrasonography, Doppler</keyword><keyword>Vena Cava, Inferior/ ultrasonography</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1553-2712 (Electronic)&#xD;1069-6563 (Linking)</isbn><accession-num>21040104</accession-num><urls></urls></record></Cite></EndNote>Chen L, 2010Prospective observational study USTo validate the use of bedside ultrasound measurement of IVC/Ao diameter by investigating whether IVC/Ao ratio correlated with dehydration in children with AGE. To investigate the inter-rater variability of the IVC/Ao measurements. ED1126 mo-18 yGESensitivity, specificity, likelihood ratios, area under the receiver operator characteristic curves.IVC to Ao diameter was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis ADDIN EN.CITE <EndNote><Cite><Author>Levine</Author><Year>2010</Year><RecNum>9627</RecNum><record><rec-number>9627</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Levine, A. C.</author><author>Shah, S. P.</author><author>Umulisa, I.</author><author>Munyaneza, R. B.</author><author>Dushimiyimana, J. M.</author><author>Stegmann, K.</author><author>Musavuli, J.</author><author>Ngabitsinze, P.</author><author>Stulac, S.</author><author>Epino, H. M.</author><author>Noble, V. E.</author></authors></contributors><auth-address>Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA. adam_levine@brown.edu</auth-address><titles><title>Ultrasound assessment of severe dehydration in children with diarrhea and vomiting</title><secondary-title>Acad Emerg Med</secondary-title></titles><periodical><full-title>Acad Emerg Med</full-title></periodical><pages>1035-41</pages><volume>17</volume><number>10</number><keywords><keyword>Aorta/ ultrasonography</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Confidence Intervals</keyword><keyword>Dehydration/etiology/physiopathology/ therapy</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea/ complications/diagnosis/therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Hemodynamics/physiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>ROC Curve</keyword><keyword>Risk Assessment</keyword><keyword>Rwanda</keyword><keyword>Severity of Illness Index</keyword><keyword>Treatment Outcome</keyword><keyword>Ultrasonography, Doppler</keyword><keyword>Vena Cava, Inferior/ ultrasonography</keyword><keyword>Vomiting/complications/diagnosis/therapy</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1553-2712 (Electronic)&#xD;1069-6563 (Linking)</isbn><accession-num>21040103</accession-num><urls></urls></record></Cite></EndNote>Levine AC, 2010Prospective cohort study Rwanda To determine the test characteristics for two different ultrasound measures of severe dehydration in children (Ao to IVC) ratio and IVC inspiratory collapse and the WHO dehydration scale. ED731 mo-10 yDiarrhea and/or vomiting Sensitivity, specificity, likelihood ratios, area under the receiver operator characteristic curves.Ao to IVC and IVC inspiratory collaps. Ultrasound if the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea. AGE= acute gastroenteritis; Ao=aorta; ED=emergency department. IVC=inferior vena cava; WHO=World Health Organization.Table 2.3.6. Hand-held bladder ultrasoundReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Enright</Author><Year>2010</Year><RecNum>12452</RecNum><record><rec-number>12452</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Enright, K.</author><author>Beattie, T.</author><author>Taheri, S.</author></authors></contributors><auth-address>Royal Hospital for Sick Children Edinburgh, Scotland. kevje26@</auth-address><titles><title>Use of a hand-held bladder ultrasound scanner in the assessment of dehydration and monitoring response to treatment in a paediatric emergency department</title><secondary-title>Emerg Med J</secondary-title></titles><periodical><full-title>Emerg Med J</full-title></periodical><pages>731-3</pages><volume>27</volume><number>10</number><keywords><keyword>Child, Preschool</keyword><keyword>Dehydration/therapy/ ultrasonography</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Fluid Therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Pediatrics</keyword><keyword>Pilot Projects</keyword><keyword>Practice Guidelines as Topic</keyword><keyword>Prospective Studies</keyword><keyword>Ultrasonography/instrumentation</keyword><keyword>Urinary Bladder/ ultrasonography</keyword><keyword>Urine</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1472-0213 (Electronic)&#xD;1472-0205 (Linking)</isbn><accession-num>20659886</accession-num><urls></urls></record></Cite></EndNote>Enright K, 2010Prospective observational study UKTo evaluate the utility of a hand-held bladder ultrasound scanner in monitoring urine production in children attending the emergency department with suspected dehydration. Tertiary ED 454 mo – 10 y Possible dehydration Primary: the ability to document the hourly rate of urine production for each child, using the hand-held bladder scanner. Secondary: the relationship between the measured urine production and clinical features of dehydration, patient disposal and rehydration therapy. Serial bladder ultrasound scanning using a hand-held device is a convenient non-invasive and objective adjunct in the management of suspected dehydration in ED. ED=emergency department;Table 2.3.7. Digital videography to measure capillary refill time Reference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Shavit</Author><Year>2006</Year><RecNum>11115</RecNum><record><rec-number>11115</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shavit, I.</author><author>Brant, R.</author><author>Nijssen-Jordan, C.</author><author>Galbraith, R.</author><author>Johnson, D. W.</author></authors></contributors><auth-address>Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.</auth-address><titles><title>A novel imaging technique to measure capillary-refill time: improving diagnostic accuracy for dehydration in young children with gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>2402-8</pages><volume>118</volume><number>6</number><keywords><keyword>Blood Flow Velocity</keyword><keyword>Capillaries/ physiopathology</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology/ physiopathology</keyword><keyword>Diagnostic Techniques and Procedures</keyword><keyword>Gastroenteritis/ chemically induced</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Prospective Studies</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2006</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>17142525</accession-num><urls></urls></record></Cite></EndNote>Shavit I, 2006Prospective cohort study Canada To determine whether digitally measured capillary-refill time assesses the presence of significant dehydration (≥5%) in young children with GE more accurately than conventional capillary refill and overall clinical assessment. Tertiary ED 83 1 mo – 5 yGastroenteritis judged to be at least mildly dehydrated. Sensitivity, specificity, likelihood ratios, area under the receiver operator characteristic curves. Digitally measured capillary-refill time more accurately predicts significant dehydration (≥5%) in young children with GE than overall clinical assessment. ED=emergency department; GE=gastroenteritis.Table 2.3.8. Bioelectric impedanceReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Dunkelmann</Author><Year>2012</Year><RecNum>11996</RecNum><record><rec-number>11996</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dunkelmann, L.</author><author>Bucher, B. S.</author><author>Tschumi, S.</author><author>Duppenthaler, A.</author><author>Simonetti, G. D.</author></authors></contributors><auth-address>.Division of Paediatric Nephrology, University Children&apos;s Hospital Berne and University of Berne, Bern, Switzerland.</auth-address><titles><title>Estimation of dehydration using bioelectric impedance in children with gastroenteritis</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>e479-81</pages><volume>101</volume><number>10</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology/therapy</keyword><keyword>Electric Impedance/diagnostic use</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>22758894</accession-num><urls></urls></record></Cite></EndNote>Dunkelmann L, 2012Case series Switzerland To compare a bioimpedance device to the validated clinical score for the determination of the degree of dehydration in children with AGE. 26 0.5 to 10 yAGEThe subgroup of children with mild dehydration (n=14) had significantly lower Ω50 compared to the subgroup of children with moderate/severe dehydration (n=12), p=0.003.Possible usefulness of bioelectric impedance for the assessment of dehydration. AGE= acute gastroenteritis;Table 2.3.9. Plasma waterReference Study design Country AimSetting NAge rangeInclusion criteria Outcome measuresResults/conclusions ADDIN EN.CITE <EndNote><Cite><Author>Plaisier</Author><Year>2010</Year><RecNum>9934</RecNum><record><rec-number>9934</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Plaisier, A.</author><author>Maingay-de Groof, F.</author><author>Mast-Harwig, R.</author><author>Kalkman, P. M.</author><author>Wulkan, R. W.</author><author>Verwers, R.</author><author>Neele, M.</author><author>Hop, W. C.</author><author>Groeneweg, M.</author></authors></contributors><auth-address>Department of Pediatrics, Maasstad Hospital, P.O. Box 9100, 3075 EA, Rotterdam, The Netherlands.</auth-address><titles><title>Plasma water as a diagnostic tool in the assessment of dehydration in children with acute gastroenteritis</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>883-6</pages><volume>169</volume><number>7</number><keywords><keyword>Acute Disease</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ diagnosis/etiology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Plasma/ chemistry</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prospective Studies</keyword><keyword>Reproducibility of Results</keyword><keyword>Weight Loss</keyword></keywords><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>20127111</accession-num><urls></urls></record></Cite></EndNote>Plaisier A, 2010Prospective cohort study The Netherlands To evaluate plasma water as a diagnostic tool in the assessment of dehydration in children with AGE admitted to hospital with moderate to severe dehydration. ED 101Up to 12 y AGE and dehydration Plasma water did not correlate with the percentage of weight loss. There is insufficient evidence to justify the use of plasma water as a diagnostic tool in the assessment of dehydration in children with AGE. AGE=acute gastroenteritis; ED=emergency department; GE=gastroenteritis.DIAGNOSTIC WORKUPTable 3.1. Is There Any Reliable Hematological Marker of Bacterial Diarrhea?ReferenceType of StudyCountryInpatient OutpatientFollow-up n/NPopulationInterventionComparisonOutcome measuresResults /Effect sizeRisk of BiasSource of FundingConclusions and Comments ADDIN EN.CITE <EndNote><Cite><Author>Wiegering</Author><Year>2011</Year><RecNum>11907</RecNum><record><rec-number>11907</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiegering, V.</author><author>Kaiser, J.</author><author>Tappe, D.</author><author>Weissbrich, B.</author><author>Morbach, H.</author><author>Girschick, H. J.</author></authors></contributors><auth-address>Pediatric Stem Cell Transplantation and Oncology Unit, Department of Pediatrics, University Hospital Wurzburg, Josef-Schneider-Str. 2, 97080 Wurzburg, Germany. Wiegering_V@klinik.uni-wuerzburg.de</auth-address><titles><title>Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>e401-7</pages><volume>15</volume><number>6</number><keywords><keyword>Adenoviridae/isolation &amp; purification</keyword><keyword>Adenoviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/epidemiology/physiopathology/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross Infection/epidemiology/microbiology/physiopathology/virology</keyword><keyword>Diarrhea/epidemiology/microbiology/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/microbiology/ physiopathology/virology</keyword><keyword>Germany/epidemiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Norovirus/isolation &amp; purification</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Rotavirus Infections/epidemiology/physiopathology/virology</keyword><keyword>Salmonella Infections/epidemiology/microbiology/physiopathology</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>21489842</accession-num><urls></urls></record></Cite></EndNote>Wiegering V, 2011RetrospectiveApr 2005 to May 2008GermanyInpatientNot reported650/1157 children with pathogen proven AGE Age 22d-17.9y(mean 2.4y)NAClinical score to differentiate between different etiologiesEtiologyDuration of diarrheaLaboratory and other hematologic markersEtiology:84.9% viral 7.9% Salmonella7.2% multiple agentsDuration of diarrhea:All viral 3.4±0.1 daysSalmonella 6.1±0.4 days (p<0.001)CRPViral AGE 1.2±0.1Salmonella AGE 6.9±0.4(p<0.001)ESRViral AGE 15±0.8Salmonella AGE 27±2.2(p<0.001)NANoneRV was the commonest cause of viral AGE and Salmonella the commonest cause of bacterial AGEChildren with bacterial AGE were older, had a more severe clinical course, significantly longer duration and significantly more elevated inflammatory markersThese parameters may make possible to differentiate between viral and bacterial AGE ADDIN EN.CITE <EndNote><Cite><Author>Marcus</Author><Year>2007</Year><RecNum>10843</RecNum><record><rec-number>10843</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marcus, N.</author><author>Mor, M.</author><author>Amir, L.</author><author>Mimouni, M.</author><author>Waisman, Y.</author></authors></contributors><auth-address>Unit of Emergency Medicine, Schneider Children&apos;s Medical Center of Israel, Petah Tiqva, Israel.</auth-address><titles><title>The quick-read C-reactive protein test for the prediction of bacterial gastroenteritis in the pediatric emergency department</title><secondary-title>Pediatr Emerg Care</secondary-title></titles><periodical><full-title>Pediatr Emerg Care</full-title></periodical><pages>634-7</pages><volume>23</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Analysis of Variance</keyword><keyword>Bacteremia/ diagnosis</keyword><keyword>C-Reactive Protein/ analysis</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Gastroenteritis/blood/ diagnosis/microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Point-of-Care Systems</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prospective Studies</keyword><keyword>ROC Curve</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2007</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1535-1815 (Electronic)&#xD;0749-5161 (Linking)</isbn><accession-num>17876252</accession-num><urls></urls></record></Cite></EndNote>Marcus N, 2007ProspectiveConvenient sampleAug 2002 toFeb 2003IsraelOutpatientER7-12 days (med 2.4)75 children AGEAge 4d - 17y44 children included Bacterial 8/44 (18%)Viral AGE 36/44 (82%)NABacterial vs Viral AGEValidity and feasibility of QR-CRP in diagnosis of bacterial vs viral AGE QR-CRP (mg/L), mean±SDBacterial 22.3.8±150.3Viral 30±50(P<0.001)QR-CRP ≥ 24.5 mg/LOR 1.49 (95%CI 1.13-1.90PPV 70%, NPV 97%QR-CRP ≥ 95 mg/LOR 1.49 (95%CI 1.13-1.90PPV 91.7%, NPV 87%NAQR-CRP assay kit was provided by OrionDiagnosFinlandCRP levels of 95mg/L or more within 48 hours of presentation had a high sensitivity and specificity for predicting culture-confirmed bacterial AGE ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2012</Year><RecNum>8943</RecNum><record><rec-number>8943</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, S. M.</author><author>Ku, M. S.</author><author>Lee, M. Y.</author><author>Tsai, J. D.</author><author>Sheu, J. N.</author></authors></contributors><auth-address>Institute of Medicine, Chung Shan Medical University, Taiwan.</auth-address><titles><title>Diagnostic performance of serum interleukin-6 and interleukin-10 levels and clinical predictors in children with rotavirus and norovirus gastroenteritis</title><secondary-title>Cytokine</secondary-title></titles><periodical><full-title>Cytokine</full-title></periodical><pages>299-304</pages><volume>59</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Caliciviridae Infections/blood/diagnosis/virology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ blood/diagnosis/microbiology/ virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Interleukin-10/ blood</keyword><keyword>Interleukin-6/ blood</keyword><keyword>Leukocyte Count</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Norovirus/ physiology</keyword><keyword>Prognosis</keyword><keyword>ROC Curve</keyword><keyword>Rotavirus/ physiology</keyword><keyword>Rotavirus Infections/blood/diagnosis/virology</keyword><keyword>Salmonella/physiology</keyword><keyword>Salmonella Infections/blood/diagnosis/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1096-0023 (Electronic)&#xD;1043-4666 (Linking)</isbn><accession-num>22592039</accession-num><urls></urls></record></Cite></EndNote>Chen SM, 2012ProspectiveMarch 2008 toJan 2009 TaiwanInpatientsNA168 childrenAGEAge 4m- 14yPathogens identified in 123/16882 viral AGE36 bacterial AGEIL-6, IL-10 assayed:55 viral AGE 26 Salmonel11 healthy controlsNABacterial vs Viral AGEDiagnostic performanceIL-6, IL-10,ANC, CRPRV vs NVViral vs bacterial AGERV vs SalmonellaANC, mm3 8075 (4225-13407) vs4444 (3118-5867)P= 0.004CRP, mg/dl0.62 (0.3-1.59) vs6.42 (3.06-12.25)P≤ 0.001IL-6, IL-10 (p<0.001)RV vs NVAUC±SE (95% CI)IL-6 0.663±0.075(0.515±0.81)P=0.039IL-100.710±0.69 (0.574-0.84)P= 0.008NAChung Shan Hospital(CSH 97A-03)IL-10 exhibited a significant high level in the acute phase of RV and NV AGE in children and showed a significant discriminating ability between the two most common viral pathogens ADDIN EN.CITE <EndNote><Cite><Author>Korczowski</Author><Year>2004</Year><RecNum>907</RecNum><record><rec-number>907</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Korczowski, B.</author><author>Szybist, W.</author></authors></contributors><auth-address>Department of Pediatrics and Pediatric Gastroenterology, District Hospital No. 2, University of Rzeszow, Poland. bartosz@uw.rzeszow.pl</auth-address><titles><title>Serum procalcitonin and C-reactive protein in children with diarrhoea of various aetiologies</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>169-73</pages><volume>93</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>C-Reactive Protein/ metabolism</keyword><keyword>Calcitonin/ blood</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ blood/ etiology/microbiology</keyword><keyword>Enterocolitis/complications/microbiology</keyword><keyword>Escherichia coli Infections/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Neisseriaceae Infections/microbiology</keyword><keyword>Protein Precursors/ blood</keyword><keyword>Rotavirus Infections/microbiology</keyword><keyword>Staphylococcal Infections/microbiology</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0803-5253 (Print)</isbn><accession-num>15046268</accession-num><urls></urls></record></Cite></EndNote>Korczowski B, 2004Prospective PolandInpatientsNA129 children diarrhea37 systemic infections36 bacterial AGE43 RV AGE13 IBDNADifferent etiologies of diarrheaPerformance of PCT compared to CRPPCT> 5ng/ml 100% systemic infections61% bacterial AGE7% RV AGE23% IBDCRP> 2mg/dl89% systemic infections61% bacterial AGE19% RV AGE46% IBDNANone declaredIn this study PCT was a more reliable marker than CRP of systemic bacterial infection in children with diarrhea. PCT was more specific but less sensitive in the differentiation of bacterial and non-bacterial etiology of inflammation.AGE= acute gastroenteritis; ANC=absolute neutrophil count; AUC=area under the curve; IL-6=interleukin 6; IL-10=interleukin 10; CI=confidence interval; CRP=C-reactive protein; NPV=negative predictive value; NV=norovirus; OR=odds ratio; PCT=procalcitonin; PPV=positive predictive value; QR-CRP=quick-read C-reactive protein; RV= rotavirus; SE=sensitivity; SP=specificity.Table 3.2. Stool markers for identification of bacterial diarrheaReferenceType of StudyCountryInpatient OutpatientFollow-up n/NPopulationInterventionComparisonOutcome measuresResults /Effect sizeRisk of BiasSource of FundingConclusions and Comments ADDIN EN.CITE <EndNote><Cite><Author>Sykora</Author><Year>2010</Year><RecNum>9854</RecNum><record><rec-number>9854</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sykora, J.</author><author>Siala, K.</author><author>Huml, M.</author><author>Varvarovska, J.</author><author>Schwarz, J.</author><author>Pomahacova, R.</author></authors></contributors><auth-address>Department of Pediatrics, Faculty Hospital, Charles University in Prague, Faculty of Medicine in Pilsen, Pilsen, The Czech Republic. sykorajo@fnplzen.cz</auth-address><titles><title>Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritis</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>1389-95</pages><volume>99</volume><number>9</number><keywords><keyword>Acute Disease</keyword><keyword>Bacterial Infections/ diagnosis</keyword><keyword>Biological Markers/metabolism</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diagnosis, Differential</keyword><keyword>Diarrhea/etiology</keyword><keyword>Feces/chemistry</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ diagnosis/ microbiology/virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Leukocyte L1 Antigen Complex/ metabolism</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>ROC Curve</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Virus Diseases/diagnosis</keyword></keywords><dates><year>2010</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>20412103</accession-num><urls></urls></record></Cite></EndNote>Sykora J, 2010Prospective Czech RepublicInpatients and OutpatientNA66 children AGE Age 1-36m34 bacterial32 viral25 unknown41 healthy controlsNABGAvsVGEReference fCP in healthy childrenPerformance of fCP in bacterial vs viral AGEfCPBGA 219.9?g/g (119-350)P<0.001 vs VGE/ controlVGE 49.3?g/g (8.8-131.1)Controls 26.5?g/g (14.9-55)fCP≥103.9 ?g/gAUC 0.95 (CI 0.89-0.98)CRP≥16.9mg/mlAUC 0.87 (0.83-0.96)WBC≥9.5X103AUC 0.77 (0.69-0.82)ESR≥15MM/HAUC 0.84 (0.79-0.89)AUC fCP vs CRP, p<0.05AUC fCP vs WBC, p<0.001AUC fCP vs ESR, p<0.01AUC fCP vs IL-6, p<0.001NANone declaredfCP is a valuable, non-invasive and esily measured laboratory testfCP is variable and is age dependent in children <3 yearsfCP was superior to clinical symptoms (fever, stool frequency and vomiting ) and laboratory (CRP, WBC) in the diagnosis of bacterial AGE. ADDIN EN.CITE <EndNote><Cite><Author>Opintan</Author><Year>2010</Year><RecNum>9663</RecNum><record><rec-number>9663</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Opintan, J. A.</author><author>Newman, M. J.</author><author>Ayeh-Kumi, P. F.</author><author>Affrim, R.</author><author>Gepi-Attee, R.</author><author>Sevilleja, J. E.</author><author>Roche, J. K.</author><author>Nataro, J. P.</author><author>Warren, C. A.</author><author>Guerrant, R. L.</author></authors></contributors><auth-address>Department of Microbiology, University of Ghana Medical School, Accra, Ghana. japh_opintan@</auth-address><titles><title>Pediatric diarrhea in southern Ghana: etiology and association with intestinal inflammation and malnutrition</title><secondary-title>Am J Trop Med Hyg</secondary-title></titles><periodical><full-title>Am J Trop Med Hyg</full-title></periodical><pages>936-43</pages><volume>83</volume><number>4</number><keywords><keyword>Case-Control Studies</keyword><keyword>Child Nutrition Disorders/ complications/epidemiology</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Diarrhea/ complications/ epidemiology/etiology</keyword><keyword>Dysentery, Bacillary/complications/epidemiology/microbiology</keyword><keyword>Enterohemorrhagic Escherichia coli/genetics/pathogenicity</keyword><keyword>Escherichia coli Infections/complications/epidemiology/microbiology</keyword><keyword>Feces/chemistry/microbiology/parasitology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Ghana/epidemiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Lactoferrin/analysis</keyword><keyword>Male</keyword><keyword>Parasitic Diseases/complications/epidemiology/parasitology</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Prospective Studies</keyword><keyword>Virulence</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1476-1645 (Electronic)&#xD;0002-9637 (Linking)</isbn><accession-num>20889896</accession-num><urls></urls></record></Cite></EndNote>Opintan JA, 2010Prospective Cross-sectionalAug 2007 to May 2008GhanaOutpatientNAChildren<5y170 AGE104 controls without diarrheaNAWell nourish vs MalnurishedEtiology of bacterial AGE Fecal lactoferrin in AGE vs controlsBacterial agents isolated161/170 AGE80/104 controlsEAEC isolated145/170 diarrhea79/84 controls without diarrheaf-Lactoferrin, ?g/mlChildren with diarrhea, n=1431658.9±204.2Control without diarrhea, n=84935.5±194.4P=0.019NAGhana University and Pfizer-fundsVirginia University USEAEC and cryptosporidium were the most common agents isolated in children with and without diarrhea in this study in children < 5 years from Ghana Fecal lactoferrin was significantly elevated in children with diarrhea ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2011</Year><RecNum>9155</RecNum><record><rec-number>9155</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, C. C.</author><author>Chang, C. J.</author><author>Lin, T. Y.</author><author>Lai, M. W.</author><author>Chao, H. C.</author><author>Kong, M. S.</author></authors></contributors><auth-address>Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China.</auth-address><titles><title>Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea</title><secondary-title>World J Gastroenterol</secondary-title></titles><periodical><full-title>World J Gastroenterol</full-title></periodical><pages>4218-24</pages><volume>17</volume><number>37</number><keywords><keyword>Biological Markers/analysis</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ microbiology/ physiopathology</keyword><keyword>Feces/ chemistry</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Lactoferrin/ analysis</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Clark scores</keyword><keyword>Diarrhea</keyword><keyword>Generalized estimating equations</keyword><keyword>Lactoferrin</keyword><keyword>Vesikari scores</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct 7</date></pub-dates></dates><isbn>1007-9327 (Print)&#xD;1007-9327 (Linking)</isbn><accession-num>22072854</accession-num><urls></urls></record></Cite></EndNote>Chen CC, 2011Prospective Cross-sectionalSept 2008 to May 2010TaiwanInpatientNA117 childrenAge 3.23y(3m-10y)NAClinical severity of infectious diarrhea(Vesikari and Clark scores)Fecal lactoferrin as marker of severity of AGEAGE etiology41/117 RV 28/41 NV31/117 Salmonella17/117 Campylobacterf-Lactoferrin, ?g/gRV 2.82±1.27NV 3.16±1.18Salmonells 11.17±2.73(p<0.05 vs viral)Campylobacter 10.32±2.9(p<0.05 vs viral)f-Lactoferrin, ?g/gSevere AGE 11.32±3.29P<0.05 vs moderate AGEP<0.05 vs mild AGEModerate 3.77±2.08Mild 1.51±1.36NAChung Shan HospitalGrantsFecal lactoferrin is a non-invasive marker able to predict bacterial vs viral infection, and the relative values may be associated with the severity of AGE, corresponding to Vesikari and Clark scoresAGE=acute gastroenteritis; AUC=area under the curve; BGA=bacterial acute gastroenteritis; CRP=C-reactive protein; EAEC=enteroaggregative E coli; fCP=fecal calprotectin; NV=norovirus; RV=rotavirus; VGE= viral acute gastroenteritis.Table 3.3. Does Any Biochemical Test Change the Approach to the Child With Gastroenteritis? (Biochemistry)ReferenceType of StudyCountryInpatientOutpatientFollow-up n/NPopulationInterventionComparisonOutcome measuresResults /Effect sizeRisk of BiasSource of FundingConclusions and Comments ADDIN EN.CITE <EndNote><Cite><Author>Hayajneh</Author><Year>2010</Year><RecNum>10150</RecNum><record><rec-number>10150</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hayajneh, W. A.</author><author>Jdaitawi, H.</author><author>Al Shurman, A.</author><author>Hayajneh, Y. A.</author></authors></contributors><auth-address>Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. wailh@just.edu.jo</auth-address><titles><title>Comparison of clinical associations and laboratory abnormalities in children with moderate and severe dehydration</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>290-4</pages><volume>50</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Area Under Curve</keyword><keyword>Blood Glucose</keyword><keyword>Creatine/blood</keyword><keyword>Dehydration/blood/ complications/diagnosis</keyword><keyword>Female</keyword><keyword>Gastroenteritis/blood/ complications</keyword><keyword>Humans</keyword><keyword>Hyperkalemia/ etiology</keyword><keyword>Hypernatremia/ etiology</keyword><keyword>Jordan</keyword><keyword>Male</keyword><keyword>Potassium/blood</keyword><keyword>Prospective Studies</keyword><keyword>ROC Curve</keyword><keyword>Reference Values</keyword><keyword>Severity of Illness Index</keyword><keyword>Sodium/blood</keyword><keyword>Uremia/ etiology</keyword></keywords><dates><year>2010</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>19644395</accession-num><urls></urls></record></Cite></EndNote>Hayajneh WA, 2010Prospective Cross-sectional Jan 2007 to May 2007JordanInpatientNA251 childrenAGEDehydrationSevere 9%Mild 91% NADehydration severityClinical and laboratory associations with severity of dehydrationSevere vs mild dehydration:More hyperNa52% vs 3%, p<0.001More hyperK17% vs 3%, p<0.001Less isoNa39% vs 95%, p<0.001Mean urea,mmol/L16.2 vs 5.5, p<0.001Mean creatinine,?mol/L69 vs 38, p<0.001Mean glucose, mmol/L 5.9 vs 4.7, p<0.001 AUC urea0.991 (95%CI 0.98-1.001)P<0.001AUC Natrium0.862 (95% CI 0.74-0.97)P<0.001AUC creatinine0.850 (95%CI 0.75-0.94)P<0.001AUC Kalium0.69 (CI 95% 0.55-0.82)P<0.006AUC glucose 0.684 (CI 95% 0.57-0.79)P<0.007NANone declaredHistorical and clinical characteristics in this cohort did not correlate with the degree of dehydrationSerum urea, creatinine, sodium, potassium and glucose were independently correlated with the degree of dehydration. Serum urea performed bestThe results from this study are in conflict with the results from previous studies and AAP and ESPGHAN guidelines ADDIN EN.CITE <EndNote><Cite><Author>Steiner</Author><Year>2007</Year><RecNum>10968</RecNum><record><rec-number>10968</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Steiner, M. J.</author><author>Nager, A. L.</author><author>Wang, V. J.</author></authors></contributors><auth-address>Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, CA, USA. msteiner@med.unc.edu</auth-address><titles><title>Urine specific gravity and other urinary indices: inaccurate tests for dehydration</title><secondary-title>Pediatr Emerg Care</secondary-title></titles><periodical><full-title>Pediatr Emerg Care</full-title></periodical><pages>298-303</pages><volume>23</volume><number>5</number><keywords><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Dehydration/diagnosis/epidemiology/etiology/therapy/ urine</keyword><keyword>Diuresis</keyword><keyword>Emergency Service, Hospital/ statistics &amp; numerical data</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/complications</keyword><keyword>Hospitals, Pediatric/statistics &amp; numerical data</keyword><keyword>Hospitals, Teaching/statistics &amp; numerical data</keyword><keyword>Hospitals, Urban/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Ketones/urine</keyword><keyword>Los Angeles/epidemiology</keyword><keyword>Male</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prospective Studies</keyword><keyword>Reagent Strips</keyword><keyword>Risk</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Severity of Illness Index</keyword><keyword>Specific Gravity</keyword><keyword>Urinalysis/ methods/statistics &amp; numerical data</keyword></keywords><dates><year>2007</year><pub-dates><date>May</date></pub-dates></dates><isbn>1535-1815 (Electronic)&#xD;0749-5161 (Linking)</isbn><accession-num>17505271</accession-num><urls></urls></record></Cite></EndNote>Steiner MJ, 2007Prospective cohort studyConvenience sampleUSAOutpatient ERVariable 74/79 Children AGEAge 17.3m(3-36m)NAPresence of dehydrationUrine specific gravity, urine ketones and output during rehydrationUrine specific gravity correlation with % dehydrationr=-0.06, p=0.64Urine ketone levels correlation with % dehydrationr=0.08, p=0.52Urine output during rehydrationcorrelation with % dehydrationr=0.01, p=0.96NANone declaredElevated urine specific gravity and urine ketones , low urine output were not useful diagnostic tests for the identification of dehydration during the initial assessment of children with AGE AAP=American Academy of Pediatrics; AGE=acute gastroenteritis; AUC=area under the curve; CI=confidence interval; ER=Emergency room; ESPGHAN= European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.HOSPITAL MANAGEMENTTable 4.1. What are the indications for hospitalization?ReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Pockett</Author><Year>2011</Year><RecNum>11910</RecNum><record><rec-number>11910</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pockett, R. D.</author><author>Adlard, N.</author><author>Carroll, S.</author><author>Rajoriya, F.</author></authors></contributors><auth-address>Epidemiologist, Cardiff Research Consortium Ltd, UK.</auth-address><titles><title>Paediatric hospital admissions for rotavirus gastroenteritis and infectious gastroenteritis of all causes in England: an analysis of correlation with deprivation</title><secondary-title>Curr Med Res Opin</secondary-title></titles><periodical><full-title>Curr Med Res Opin</full-title></periodical><pages>777-84</pages><volume>27</volume><number>4</number><keywords><keyword>Child, Preschool</keyword><keyword>Comorbidity</keyword><keyword>Diabetes Mellitus, Type 1/complications/epidemiology</keyword><keyword>England/epidemiology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ epidemiology/etiology</keyword><keyword>Geography</keyword><keyword>Hospitals, Pediatric/ statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Patient Admission/ statistics &amp; numerical data</keyword><keyword>Psychosocial Deprivation</keyword><keyword>Retrospective Studies</keyword><keyword>Rotavirus Infections/complications/ epidemiology</keyword><keyword>Socioeconomic Factors</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1473-4877 (Electronic)&#xD;0300-7995 (Linking)</isbn><accession-num>21294699</accession-num><urls></urls></record></Cite></EndNote>Pockett RD, 2011Retrospective cohort study+/-UKInpatientsN=1334 children ≤5 yr of age with RV-AGE——Correlation with deprivation rank——Variation of hospital admissions' rates in relation to the decrease of a deprivation ranking* Rates from 0.346 to 0.287 per 10,000 (p?<?0.001)Hospital admissions increased as deprivation increased**Index of Multiple Deprivation (IMD) 2007 for England ADDIN EN.CITE <EndNote><Cite><Author>Kyle</Author><Year>2011</Year><RecNum>12383</RecNum><record><rec-number>12383</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kyle, R. G.</author><author>Kukanova, M.</author><author>Campbell, M.</author><author>Wolfe, I.</author><author>Powell, P.</author><author>Callery, P.</author></authors></contributors><auth-address>Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling, Stirling, UK. richard.kyle@stir.ac.uk</auth-address><titles><title>Childhood disadvantage and emergency admission rates for common presentations in London: an exploratory analysis</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>221-6</pages><volume>96</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Age Distribution</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/epidemiology/etiology</keyword><keyword>Emergencies</keyword><keyword>Female</keyword><keyword>Fever/epidemiology/etiology</keyword><keyword>Hospitalization/ statistics &amp; numerical data</keyword><keyword>Housing</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>London/epidemiology</keyword><keyword>Male</keyword><keyword>Poverty</keyword><keyword>Respiration Disorders/ epidemiology/etiology</keyword><keyword>Retrospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Urban Health/statistics &amp; numerical data</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1468-2044 (Electronic)&#xD;0003-9888 (Linking)</isbn><accession-num>20880940</accession-num><urls></urls></record></Cite></EndNote>Kyle RG, 2011Retrospective study+UKInpatients (ED)24,481 children under 15 years admitted to ED for breathing difficulty, fever or diarrhoea during 2007/2008.NoNoNo__Index of Multiple DeprivationSperman rho0.31, p=0.09There were no statistically significant relationships between the ED admission rate of children admitted for diarrhoea and the Index multiple derivation and its single indicators.overcrowding Sperman rho0.21, p=0.267houses in poor conditionSperman rho0.11, p=0.543 air qualitySperman rho0.16, p=0.387homelessnessSperman rho0.14, p=0.439 ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2011</Year><RecNum>9518</RecNum><record><rec-number>9518</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Gouin, S.</author><author>Bhatt, M.</author><author>Black, K. J.</author><author>Johnson, D.</author><author>Guimont, C.</author><author>Joubert, G.</author><author>Porter, R.</author><author>Doan, Q.</author><author>van Wylick, R.</author><author>Schuh, S.</author><author>Atenafu, E.</author><author>Eltorky, M.</author><author>Cho, D.</author><author>Plint, A.</author></authors></contributors><auth-address>Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada. stephen.freedman@sickkids.ca</auth-address><titles><title>Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e287-95</pages><volume>127</volume><number>2</number><keywords><keyword>Age Factors</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/ economics/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Physician&apos;s Practice Patterns/ standards</keyword><keyword>Prospective Studies</keyword><keyword>Retrospective Studies</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>21262881</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2011Prospective cohort study+CanadaInpatients (ED)647 children 3-48 months admitted to 11 different ED. Exclusion: children already enrolled in other studies or families that were unavailable/unable to complete telephone follow-upNoNoNo 398/446 (89%) _proportion of children treated with IV rehydrationnumber and %149/647 (23%, range 6-66%)The use of IV rehydration varied dramatically among different institutions. IV rehydration at the index visit was significantly associated with the institution providing care and was not associated with a reduction in the need for follow-up carerisk of readmission after IV therapy in target visit vs no IV therapyrate20% vs 9%, p=0.002Volume of IV fluidsrange and variation15-87 ml/kg, p=0.003Predictors of IV rehydration:institution location OR (95%CI)3.0 (1.8 –5.0)vomiting bile or bloodOR (95%CI)2.6 (1.2–5.5)previous physician visitOR (95%CI)1.7 (1.0–2.7)n° vomiting in 24 hoursOR (95%CI)1.1 (1.0 –1.1) per additional episodeAGE=acute gastroenteritis; ED=Emergency department; OR=odds ratio; QoS=Quality of Study; RV=rotavirus.Table 4.2. What hygiene and isolation precautions are indicated for a child with AGE?ReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Valentini</Author><Year>2013</Year><RecNum>12388</RecNum><record><rec-number>12388</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Valentini, D.</author><author>Vittucci, A. C.</author><author>Grandin, A.</author><author>Tozzi, A. E.</author><author>Russo, C.</author><author>Onori, M.</author><author>Menichella, D.</author><author>Bartuli, A.</author><author>Villani, A.</author></authors></contributors><auth-address>Department of Pediatrics, Bambino Gesu Children&apos;s Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy, diletta.valentini@.</auth-address><titles><title>Coinfection in acute gastroenteritis predicts a more severe clinical course in children</title><secondary-title>Eur J Clin Microbiol Infect Dis</secondary-title></titles><periodical><full-title>Eur J Clin Microbiol Infect Dis</full-title></periodical><pages>909-15</pages><volume>32</volume><dates><year>2013</year><pub-dates><date>Jan 31</date></pub-dates></dates><isbn>1435-4373 (Electronic)&#xD;0934-9723 (Linking)</isbn><accession-num>23370970</accession-num><urls></urls></record></Cite></EndNote>Valentini D, 2013Prospective cohort study+ItalyInpatientsN=232 between 1 month and 16 years of age admitted for AGE—Collection of clinical data and stool samplesCoinfections vs Monoinfections232/275—Max. no of diarrhea stools/24 h (≥6)OR (95%CI)8.79 (3.32;23.28) p <0.001Coinfection with different pathogens is associated with a more severe course of symptomsDuration of diarrhea (days) (≥5)3.81 (1.47;9.86) p= 0.006Duration of vomiting (days) (≥3)7.11 (2.74;18.42) p<0.001Fever (≥38°)17.78 (2.32;136.17) p=0.006Severe dehydration (%)28.70 (3.04;270.6) p=0.003AGE=acute gastroenteritis; OR=odds ratio.Table 4.3. What are the indications for nasogastric rehydration?ReferenceStudy typeQoSCountryIn/Out PatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresRCT nEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2012</Year><RecNum>12402</RecNum><record><rec-number>12402</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Keating, L. E.</author><author>Rumatir, M.</author><author>Schuh, S.</author></authors></contributors><auth-address>Divisions of aPediatric Emergency Medicine, Hospital for Sick Children Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Health care provider and caregiver preferences regarding nasogastric and intravenous rehydration</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e1504-11</pages><volume>130</volume><number>6</number><keywords><keyword>Attitude of Health Personnel</keyword><keyword>Child, Preschool</keyword><keyword>Choice Behavior</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods/ psychology/utilization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous/ psychology/utilization</keyword><keyword>Inservice Training</keyword><keyword>Intubation, Gastrointestinal/ psychology/utilization</keyword><keyword>Male</keyword><keyword>Ontario</keyword><keyword>Parents/education/ psychology</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>23166337</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2012Prospective cross-sectional study+CanadaInpatients (ED)N=434 children aged 3-48 months with AGE; N=113 health care providers—Phase1: caregivers were asked to complete a survey on nasogastric rehydration (vs IV). Phase 2: data recorded. Phase 3: health-care providers completed a survey IV rehydration——Caregivers who did not believe that IV/NG insertion is easy (NG group vs IV group)Rates77% vs 59% (p<0.001)Most health care providers are unfamiliar with the use of NG rehydration and this treatment choice is in keeping with caregivers desiresCaregivers who did not believe that IV/NG rehydration will replenish fluids (NG group vs IV group)Rates11% vs 3% (p<0.001)Estimated pain with IV/NG insertion according to caregivers ‘perception (0=no pain 100= worst possible pain) (NG group vs IV group)Interquartiles80(60-100) vs 70(50-90); p<0.001Estimated pain with NG insertion according to health-care providers (0=no pain 100= worst possible pain) (Nurses vs Medical staff vs Fellows)Median±SD64±18 vs 52±25 vs 50±16; p=0.007Estimated percentage of vomiting in children rehydrated with NG according to health-care providers (Nurses vs Medical staff vs Fellows)Median±SD24±19 vs 11±11 vs 22±20; p=0.001Estimated percentage of shorter ED stay in children rehydrated with NG according to health-care providers (Nurses vs Medical staff vs Fellows)Rates38% vs 56% vs 75%; p<0.001MA (17 RCTs)++High income (USA, Australia, Finland) and low income (Puerto Rico, Egypt, Mexico, Iran, Afghanistan, Colombia,Peru)Inpatients and OutpatientsN=1811 (most trials included children from 3mo to 5y)—ORT orally or via NGT (40-50 ml/kg administered in 3-6 h)IV therapy——Failure to rehydrate18(1811)Weighted mean difference (95%CI)0.04 (0.01 to 0.07)see GLWeight gain (g) at discharge6 (369)Weighted mean difference (95%CI)-26 (-207 to 154) NSPercent weight gain (g) at discharge5 (767)Weighted mean difference (95%CI)-0.26 (-1.56 to 1.05) NSLength of hospital stay6 (526)Weighted mean difference (95%CI)-1.2 (-2.38 to -0.02) ↓Incidence of hyponatremia2 (248)?NSIncidence of hypernatremia10 (1062)Weighted mean difference (95%CI)0.0 (-0.01 to 0.01) NSDuration of diarrhea (h)8 (960)Weighted mean difference (95%CI)-5.9 (-12.7 to -0.89) ↓Total fluid intake (ml/kg) at 6h8 (985)Weighted mean difference (95%CI)32.1 (-26.7 to 90.9) NSTotal fluid intake (ml/kg) at 24h7 (835)Weighted mean difference (95%CI)73.45 (-31.8 to 178.7) NSPhlebytis??More often with IVTParalytic ileus??More often with ORS but NS ADDIN EN.CITE <EndNote><Cite><Author>Varavithya</Author><Year>1978</Year><RecNum>12404</RecNum><record><rec-number>12404</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Varavithya, W.</author><author>Posayanond, P.</author><author>Tontisirin, K.</author><author>Chernjitra, L.</author><author>Kashemsant, C.</author></authors></contributors><titles><title>Oral hydration in infantile diarrhoea</title><secondary-title>Southeast Asian J Trop Med Public Health</secondary-title></titles><periodical><full-title>Southeast Asian J Trop Med Public Health</full-title></periodical><pages>414-9</pages><volume>9</volume><number>3</number><keywords><keyword>Acute Disease</keyword><keyword>Blood Urea Nitrogen</keyword><keyword>Body Weight</keyword><keyword>Carbon Dioxide/blood</keyword><keyword>Diarrhea, Infantile/blood/ therapy</keyword><keyword>Electrolytes/blood</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Parenteral</keyword><keyword>Intubation, Gastrointestinal/ methods</keyword><keyword>Male</keyword><keyword>Asia</keyword><keyword>Comparative Studies</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea</keyword><keyword>Diarrhea, Infantile</keyword><keyword>Diseases</keyword><keyword>Oral Rehydration</keyword><keyword>Research Methodology</keyword><keyword>Southeastern Asia</keyword><keyword>Studies</keyword><keyword>Thailand</keyword><keyword>Treatment</keyword></keywords><dates><year>1978</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0125-1562 (Print)&#xD;0125-1562 (Linking)</isbn><accession-num>749226</accession-num><urls></urls></record></Cite></EndNote>Varavithya W, 1978RCT-ThailandInpatients N= 22, 4–17 months of age, moderate dehydrationNONasogastric Rehydration (150 mL/kg/day - 10–20 mL/kg/h for 2 h, then a costant rate over 22 h)IV rehydration with 5% dextrose 0.3% Na+ (150 mL/kg/day - 10-20 mL/kg/h for 2h, then a costant rate over 22h)22/22YesWeight gain—?Similar weight gain, oral intake, and improvement in laboratory test results between groups; sodium and osmolarity returned to normal without complications in both groups**?Stool lossOral intakeBlood Sodium OsmolaritySerum specific gravity ADDIN EN.CITE <EndNote><Cite><Author>Hidayat</Author><Year>1988</Year><RecNum>12403</RecNum><record><rec-number>12403</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hidayat, S.</author><author>Srie Enggar, K. D.</author><author>Pardede, N.</author><author>Ismail, R.</author></authors></contributors><titles><title>Nasogastric drip rehydration therapy in acute diarrhea with severe dehydration</title><secondary-title>Paediatr Indones</secondary-title></titles><periodical><full-title>Paediatr Indones</full-title></periodical><pages>79-84</pages><volume>28</volume><number>3-4</number><keywords><keyword>Acute Disease</keyword><keyword>Bicarbonates/administration &amp; dosage</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ therapy</keyword><keyword>Diarrhea/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Glucose/administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Intubation, Gastrointestinal</keyword><keyword>Male</keyword><keyword>Potassium Chloride/administration &amp; dosage</keyword><keyword>Sodium Chloride/administration &amp; dosage</keyword></keywords><dates><year>1988</year><pub-dates><date>Mar-Apr</date></pub-dates></dates><isbn>0030-9311 (Print)&#xD;0030-9311 (Linking)</isbn><accession-num>3231493</accession-num><urls></urls></record></Cite></EndNote>Hidayat S, 1988RCT-IndonesiaInpatientsN=75 , 1–59 months of age, severe dehydration (WHO) NONasogastric rehydration (WHO standard ORS) 40 ml/kg in the first hour, 30 ml/kg in the second, 20 ml/kg in the third and fourth hoursIV rehydration: lactated Ringer's solution (40 mL/kg X 1h, then 30 mL/kg X 1h, then 20 mL/kg X 2h)75/75YesWeight gain—RatesNo difference**?Hourly assessment of degree of dehydrationRatesNo difference**4-h assessment of degree of dehydrationRatesNo difference**Mean hospital stayMean differenceNo difference**Duration of vomitingMean differenceNo difference** ADDIN EN.CITE <EndNote><Cite><Author>Pignatelli</Author><Year>2000</Year><RecNum>12456</RecNum><record><rec-number>12456</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pignatelli, S.</author><author>Simpore, J.</author><author>Ruggieri, M.</author><author>Musumeci, S.</author></authors></contributors><auth-address>Camillian Medical Center, Ouagadougou, Burkina Faso.</auth-address><titles><title>Effectiveness of forced rehydration and early re-feeding in the treatment of acute diarrhoea in a tropical area</title><secondary-title>Minerva Pediatr</secondary-title></titles><periodical><full-title>Minerva Pediatr</full-title></periodical><pages>357-66</pages><volume>52</volume><number>7-8</number><keywords><keyword>Acute Disease</keyword><keyword>Administration, Oral</keyword><keyword>Arachis hypogaea</keyword><keyword>Burkina Faso</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/diet therapy/etiology/ therapy</keyword><keyword>Diarrhea/ complications</keyword><keyword>Female</keyword><keyword>Flour</keyword><keyword>Food, Formulated/utilization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant Food/utilization</keyword><keyword>Intubation, Gastrointestinal</keyword><keyword>Male</keyword><keyword>Rehydration Solutions/ administration &amp; dosage/ chemistry</keyword><keyword>Soybeans</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword><keyword>Tropical Medicine/methods</keyword><keyword>Weight Loss</keyword></keywords><dates><year>2000</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><isbn>0026-4946 (Print)&#xD;0026-4946 (Linking)</isbn><accession-num>11103592</accession-num><urls></urls></record></Cite></EndNote>Pignatelli S, 2000Prospective cohort study+Burkina FasoInpatientsN=4131 < 5y of age with acute diarrhea and severe dehydration—Nasogastric rehydration (50-100 mL/kg/day for the first 10 kg of weight and 25 to 50 mL/kg per day for the remaining)——YesIncreased weight at 4-5 h (%)—Rates3717/4131 (90%); p<.001 Safe and effective in the treatment and prevention of dehydration in developing countries Longer period of infusion (%)?Rates413/4131 (10%) ADDIN EN.CITE <EndNote><Cite><Author>Powell</Author><Year>2011</Year><RecNum>9211</RecNum><record><rec-number>9211</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Powell, C. V.</author><author>Priestley, S. J.</author><author>Young, S.</author><author>Heine, R. G.</author></authors></contributors><auth-address>Departments of aEmergency Medicine, Royal Children&apos;s Hospital, Melbourne, Australia.</auth-address><titles><title>Randomized clinical trial of rapid versus 24-hour rehydration for children with acute gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e771-8</pages><volume>128</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Body Weight</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/diagnosis/etiology/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/ complications/diagnosis/virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Intubation, Gastrointestinal</keyword><keyword>Male</keyword><keyword>Patient Admission/statistics &amp; numerical data</keyword><keyword>Patient Discharge/statistics &amp; numerical data</keyword><keyword>Patient Readmission/statistics &amp; numerical data</keyword><keyword>Severity of Illness Index</keyword><keyword>Time Factors</keyword><keyword>Treatment Failure</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>21949149</accession-num><urls></urls></record></Cite></EndNote>Powell CV, 2011Non-inferiority RCT+AustraliaInpatients (ED)N=254 , 6-72 months of age, moderate degree of dehydration (Gorelick)AppropriateRapid Nasogastric Rehydration (100 ml/kg ORS in 4 h)Standard Nasogastric Rehydration (according to the % of weight loss)207/254NOAdditional loss of >2% compared with admission weight?Rates Difference (95%CI)2.6% (-5.3% to 10.5%); p=0.524No differences between groups (Rapid in 4h vs 24 hours) in terms of efficacy and safety. However, even if RNR administered in ED could reduce the need of hospitalization, discharge failed in about one fourth of patients. Limits: ITT is missing; 21/254 patients were lost at FU and no reason provided; single-blindingInability to tolerate the insertion of NGT?Rates (95%CI)0.8% (0-2.4) vs 1.8% (0-4.4); p=0.51Persistent vomiting?Rates (95%CI)5%(1.0-9.0) vs 2.8%V(0-5.9%); p=0.38Commencement of IV rehydration?Rates (95%CI)5.9% (2.9-11.7) vs 4.9% (2.0-10.3); p=0.66Continued signs of moderate dehydration (>3 clinical signs)?Rates (95%CI)18.4%v(11.4-25.4) vs 28.4% (19.6-37.2) p=0.08Need for NGT fluids beyond 24 hours (SNR only)?Rates (95%CI)9.2% (3.7-14.7)**RouhaniAGE=acute gastroenteritis; ED=emergency department; IV=Intravenous; NG=Nasogastric; NGT=Nasogastric tube; NS= Not significant; ORS= Oral Rehydration Solution; QoS=Quality of Study; RNR=rapid nasogastric rehydration; SNR=standard nasogastric rehydration.4.4. What are the indications for intravenous rehydration?Table 4.4.1 CompositionReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcome measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Neville</Author><Year>2006</Year><RecNum>71</RecNum><record><rec-number>71</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Neville, K. A.</author><author>Verge, C. F.</author><author>Rosenberg, A. R.</author><author>O&apos;Meara, M. W.</author><author>Walker, J. L.</author></authors></contributors><auth-address>Department of Endocrinology, Sydney Children&apos;s Hospital, Sydney, Australia. kristen.neville@sesiahs.health..au</auth-address><titles><title>Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>226-32</pages><volume>91</volume><number>3</number><keywords><keyword>Anthropometry</keyword><keyword>Blood Glucose/metabolism</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Fluid Therapy/adverse effects/ methods</keyword><keyword>Gastroenteritis/ therapy</keyword><keyword>Humans</keyword><keyword>Hyponatremia/prevention &amp; control</keyword><keyword>Hypotonic Solutions/therapeutic use</keyword><keyword>Infant</keyword><keyword>Isotonic Solutions/therapeutic use</keyword><keyword>Male</keyword><keyword>Osmolar Concentration</keyword><keyword>Prospective Studies</keyword><keyword>Rehydration Solutions/adverse effects/ therapeutic use</keyword><keyword>Sodium/blood/urine</keyword></keywords><dates><year>2006</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1468-2044 (Electronic)</isbn><accession-num>16352625</accession-num><urls></urls></record></Cite></EndNote>Neville KA, 2006RCT+AustraliaInpatients (ED)124 children with AGE (62 per group). Exclusion criteria: Renal or pulmonary disease, abnormal ADH secretion, ADH active drugs, pituitary/hypotalamic disease.Not clearly describedIV rehydration with 0.45% saline in 2.5% dextrose (N/2)IV rehydration with 0.9% saline in 2.5% dextrose (NS)102/124Not clearChange in [Na] mmol/L in hyponatremic patients (N/2 vs NS)mean (SD)0.4 (1.7) vs 2.4 (2.0), p=0.003Hypotonic saline solutions exacerbate the tendency to develop dilutional hyponatremia while isotonic solutions are protective. The maximum decrease in [Na] was of 6mmol/L in the 2 patients treated with rapid hypotonic rehydrationChange in [Na] mmol/L in normonatremic patients (N/2 vs NS)mean (SD)-2.3 (2.2) vs +0.8 (2.4), p<0.001[Na] decrease > 2 mmol/L in hyponatremic patients (N/2 vs NS)prevalence13% vs 0%[Na] decrease > 2 mmol/L in normonatremic patients (N/2 vs NS)prevalence51% vs 13% ADDIN EN.CITE <EndNote><Cite><Author>Hanna</Author><Year>2010</Year><RecNum>12410</RecNum><record><rec-number>12410</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hanna, M.</author><author>Saberi, M. S.</author></authors></contributors><auth-address>Department of Pediatrics, Saint John Hospital and Medical Center, Detroit, MI, USA. mina-hanna@uiowa.edu</auth-address><titles><title>Incidence of hyponatremia in children with gastroenteritis treated with hypotonic intravenous fluids</title><secondary-title>Pediatr Nephrol</secondary-title></titles><periodical><full-title>Pediatr Nephrol</full-title></periodical><pages>1471-5</pages><volume>25</volume><number>8</number><keywords><keyword>Child</keyword><keyword>Dehydration/complications/etiology/therapy</keyword><keyword>Diarrhea/complications/etiology</keyword><keyword>Electrolytes</keyword><keyword>Female</keyword><keyword>Fluid Therapy/adverse effects</keyword><keyword>Gastroenteritis/ complications/etiology/ therapy</keyword><keyword>Glucose/administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>Hyponatremia/blood/epidemiology/ etiology</keyword><keyword>Hypotonic Solutions/administration &amp; dosage</keyword><keyword>Incidence</keyword><keyword>Infusions, Intravenous/adverse effects</keyword><keyword>Male</keyword><keyword>Retrospective Studies</keyword><keyword>Sodium/blood</keyword><keyword>Sodium Chloride</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2010</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1432-198X (Electronic)&#xD;0931-041X (Linking)</isbn><accession-num>20108002</accession-num><urls></urls></record></Cite></EndNote>Hanna M, 2010Retrospective study+/-USAInpatients141 records of patients admitted for AGE having at least two registration of serum electrolytes._10-40 ml/kg fluids containing 5% dextrose in 0.2, 0.3 or 0.45 % saline.___Development of hyponatremiaprevalence18/97 (18,5%)18,5% developed a mild hyponatremia (Na 133,4±0,9 mEq/L) ADDIN EN.CITE <EndNote><Cite><Author>Han</Author><Year>2009</Year><RecNum>10357</RecNum><record><rec-number>10357</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Han, J. J.</author><author>Yim, H. E.</author><author>Lee, J. H.</author><author>Kim, Y. K.</author><author>Jang, G. Y.</author><author>Choi, B. M.</author><author>Yoo, K. H.</author><author>Hong, Y. S.</author></authors></contributors><auth-address>Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea.</auth-address><titles><title>Albumin versus normal saline for dehydrated term infants with metabolic acidosis due to acute diarrhea</title><secondary-title>J Perinatol</secondary-title></titles><periodical><full-title>J Perinatol</full-title></periodical><pages>444-7</pages><volume>29</volume><number>6</number><keywords><keyword>Acidosis/etiology/ therapy</keyword><keyword>Albumins/ administration &amp; dosage</keyword><keyword>Dehydration/complications/etiology/ therapy</keyword><keyword>Diarrhea/ complications/therapy</keyword><keyword>Humans</keyword><keyword>Infant, Newborn</keyword><keyword>Infusions, Intravenous</keyword><keyword>Rehydration Solutions/ administration &amp; dosage</keyword><keyword>Sodium Chloride/ administration &amp; dosage</keyword></keywords><dates><year>2009</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1476-5543 (Electronic)&#xD;0743-8346 (Linking)</isbn><accession-num>19158801</accession-num><urls></urls></record></Cite></EndNote>Han JJ, 2009RCT+/-KoreaInpatients33 neonates with acidosis secondary to AGE (Ph<7.25 or BE-15). In addition to interventions, all patients received maintenance with 5% dexstrose and NaCl 20 mEq/L, correction of acidosis and potassium supplementation.Not clearly described10 ml/kg of 5% Albumin10 ml/kg of 0.9% normal saline33/33Not reportedWeight gain (Albumin vs normal saline)mean % of weight gain±SD5.08±6.33 vs 5.67±5.73, p=NS No differences either in the pH, BE and HCO3 levels, in the body weight and weight gain 4 days after treatment or in the length of hospital stay.Length of stay (Albumin vs normal saline)mean days±SD8.13±3.23 vs 9.36±4.16, p=NSPersistence of acidosis after 3 h rehydrationrate80% vs 61.1%, p=NS ADDIN EN.CITE <EndNote><Cite><Author>Levy</Author><Year>2007</Year><RecNum>11055</RecNum><record><rec-number>11055</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Levy, J. A.</author><author>Bachur, R. G.</author></authors></contributors><auth-address>Division of Emergency Medicine, Children&apos;s Hospital Boston, Harvard Medical School, Boston, MA, USA. jason.levy@childrens.harvard.edu</auth-address><titles><title>Intravenous dextrose during outpatient rehydration in pediatric gastroenteritis</title><secondary-title>Acad Emerg Med</secondary-title></titles><periodical><full-title>Acad Emerg Med</full-title></periodical><pages>324-30</pages><volume>14</volume><number>4</number><keywords><keyword>Case-Control Studies</keyword><keyword>Chi-Square Distribution</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Emergency Treatment/ methods</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Glucose/ therapeutic use</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Statistics, Nonparametric</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2007</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1553-2712 (Electronic)&#xD;1069-6563 (Linking)</isbn><accession-num>17296801</accession-num><urls></urls></record></Cite></EndNote>Levy JA, 2007Case-control study+/-USAInpatients (ED)56 cases and 112 controls arriving at the ED for dehydration due to AGE. Cases were those children requiring return visit with admission_____Risk of return visit with admission for children receiving no dextrose-containing fluidsOR [95%CI]3.9 [1.8 to 8.7] children who received more IV dextrose independently from fluid amount, were less likely to have a return visit requiring admission. Risk of return visit with admission for children receiving no dextrose-containing fluids, according to fluid amountsOR [95%CI]<500 mg/kg=3.0 [1.6 to 5.8] <750 mg/kg=3.7 [1.7 to 8.1] <1000 mg/kg= 5 [1.7 to 14.9] ADDIN EN.CITE <EndNote><Cite><Author>Hoorn</Author><Year>2004</Year><RecNum>12411</RecNum><record><rec-number>12411</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoorn, E. J.</author><author>Geary, D.</author><author>Robb, M.</author><author>Halperin, M. L.</author><author>Bohn, D.</author></authors></contributors><auth-address>Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.</auth-address><titles><title>Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>1279-84</pages><volume>113</volume><number>5</number><keywords><keyword>Acute Disease</keyword><keyword>Adolescent</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hyponatremia/ epidemiology/etiology/prevention &amp; control</keyword><keyword>Hypotonic Solutions/ administration &amp; dosage</keyword><keyword>Infant</keyword><keyword>Isotonic Solutions/administration &amp; dosage</keyword><keyword>Male</keyword><keyword>Retrospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Sodium/blood</keyword></keywords><dates><year>2004</year><pub-dates><date>May</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>15121942</accession-num><urls></urls></record></Cite></EndNote>Hoorn EJ, 2004Observational study?CanadaInpatients40 children who had a hospital-acquired hyponatremia (Na<136 mmol/L) compared with non-hyponatremic patients who had at least 2 [Na] evaluation during their stay (1:3 ratio)_____Electrolyte free water received (cases vs controls)?2±2 vs 1±1, p=0.001Cases received 3-fold more elecrolyte free water than controls and had a greater positive fluid balance than the control group (P=0.02). No significant differences related to the underlying disease. ADDIN EN.CITE <EndNote><Cite><Author>Saba</Author><Year>2011</Year><RecNum>12413</RecNum><record><rec-number>12413</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saba, T. G.</author><author>Fairbairn, J.</author><author>Houghton, F.</author><author>Laforte, D.</author><author>Foster, B. J.</author></authors></contributors><auth-address>Dept, of Pediatrics, Montreal Children&apos;s Hospital, McGill University, Montreal, QC, Canada.</auth-address><titles><title>A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children</title><secondary-title>BMC Pediatr</secondary-title></titles><periodical><full-title>BMC Pediatr</full-title></periodical><pages>82</pages><volume>11</volume><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hyponatremia/ prevention &amp; control</keyword><keyword>Hypotonic Solutions/ administration &amp; dosage</keyword><keyword>Infant</keyword><keyword>Isotonic Solutions/ administration &amp; dosage</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Sodium/blood</keyword><keyword>Sodium Chloride/ administration &amp; dosage</keyword></keywords><dates><year>2011</year></dates><isbn>1471-2431 (Electronic)&#xD;1471-2431 (Linking)</isbn><accession-num>21943218</accession-num><urls></urls></record></Cite></EndNote>Saba TG, 2011RCT+CanadaInpatients59 children (34 surgical and 25 medical, NO AGE) aged 3 months to 18 years admitted to ED for medical or surgical problems. Exclusion criteria: electhrolyte alterations, neurological, cardiac or renal illness, edema and diuretic drugs use.AdequateIV rehydration with 0.9% Saline in 5% dextrose (Isotonic)IV rehydration with 0.45% saline in 5% dextrose (Hypotonic)12/25 medical and 25/34 surgical patientsnot performed Rate of change in [Na] median [IQR]0.20[0.03 to 0.4] vs 0.08[-0.15 to 0.16]The absolute change in [Na] was greater for 0.9% saline group compared with the 0.45% group (+3mmol/L vs +1 mmol/L), but not statistically significantNumber of patients with decrease in [Na]number (%)3 (19%) vs 5 (24%)Hyponatremia [Na<136]number (%)1(6%) vs 1 (5%)Hypernatemia [Na>145]?? ADDIN EN.CITE <EndNote><Cite><Author>Yung</Author><Year>2009</Year><RecNum>12499</RecNum><record><rec-number>12499</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Yung, M.</author><author>Keeley, S.</author></authors></contributors><auth-address>Paediatric Intensive Care Unit, Women&apos;s and Children&apos;s Hospital, South Australia, Australia. michael.yung@cywhs..au</auth-address><titles><title>Randomised controlled trial of intravenous maintenance fluids</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>9-14</pages><volume>45</volume><number>1-2</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Double-Blind Method</keyword><keyword>Fluid Therapy/adverse effects/ methods</keyword><keyword>Glucose/ administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>Hyponatremia/blood/etiology/prevention &amp; control</keyword><keyword>Hypotonic Solutions/administration &amp; dosage</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous/methods</keyword><keyword>Intensive Care Units, Pediatric</keyword><keyword>Isotonic Solutions/administration &amp; dosage</keyword><keyword>Postoperative Care/methods</keyword><keyword>Sodium/blood</keyword><keyword>Sodium Chloride/ administration &amp; dosage</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2009</year><pub-dates><date>Jan-Feb</date></pub-dates></dates><isbn>1440-1754 (Electronic)&#xD;1034-4810 (Linking)</isbn><accession-num>18036144</accession-num><urls></urls></record></Cite></EndNote>Yung M, 20094 arms RCT+/-AustraliaInpatients (PICU)50 children admitted to PICU for different reasons (37 surgery, 15 of them ventilated). NO AGEAdequateRehydration with 0.9% saline (Isotonic). Subdivision in two groups 1. full maintenance regimen and 2. restricted fluidsRehydration with 4% dextrose and 0.18% saline (hyposmolar). Subdivision in two groups 1. full maintenance regimen and 2. restricted fluids50/50not performed Overall [Na] fallmean mmol/L 2.3 (+ 4.0) The change in [Na] was significantly affected by fluid type (P = 0.0063) but not fluid rate (P = 0.12). Among surgical patients, there were significantly greater falls in mean [Na] for hyposmolar compared with isosmolar fluids: 4.4 (1.9, 6.8) mmol/L, P = 0.0009[Na] fall difference (hypotonic vs isotonic)difference (95%CI) in mmol/L 3.0 (0.8–5.1), p=0.006[Na] fall difference full (maintenance vs restricted)difference (95%CI) in mmol/L1.6 (-0.7, 3.9), p=NS ADDIN EN.CITE <EndNote><Cite><Author>Akech</Author><Year>2010</Year><RecNum>12414</RecNum><record><rec-number>12414</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Akech, S. O.</author><author>Karisa, J.</author><author>Nakamya, P.</author><author>Boga, M.</author><author>Maitland, K.</author></authors></contributors><auth-address>KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.</auth-address><titles><title>Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia</title><secondary-title>BMC Pediatr</secondary-title></titles><periodical><full-title>BMC Pediatr</full-title></periodical><pages>71</pages><volume>10</volume><keywords><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Hypovolemia/mortality/ therapy</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Isotonic Solutions/ administration &amp; dosage</keyword><keyword>Kenya/epidemiology</keyword><keyword>Male</keyword><keyword>Malnutrition/mortality/ therapy</keyword><keyword>Resuscitation/ methods</keyword><keyword>Survival Rate</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2010</year></dates><isbn>1471-2431 (Electronic)&#xD;1471-2431 (Linking)</isbn><accession-num>20923577</accession-num><urls></urls></record></Cite></EndNote>Akech SO, 2010Phase II RCT+AfricaInpatientschildren with severe malnutrition and shock, septic shock BUT Not DUE TO AGE .???????? Isotonic fluids were associated with modest improvement when compared to half-strength Darrow's in 5% dextroseADH=Antidiuretic hormone; AGE=acute gastroenteritis; ED=emergency department; IV= intravenous; QoS=Quality of Study SD=standard deviation.Table 4.4.2. RegimenReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcomesOutcome measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2013</Year><RecNum>12473</RecNum><record><rec-number>12473</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Ali, S.</author><author>Oleszczuk, M.</author><author>Gouin, S.</author><author>Hartling, L.</author></authors></contributors><auth-address>Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children&apos;s Hospital, Alberta Children&apos;s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries</title><secondary-title>Evid Based Child Health</secondary-title></titles><periodical><full-title>Evid Based Child Health</full-title></periodical><pages>1123-37</pages><volume>8</volume><number>4</number><keywords><keyword>anti?€?emetics</keyword><keyword>dehydration</keyword><keyword>diarrhoea</keyword><keyword>gastroenteritis</keyword><keyword>probiotics</keyword><keyword>rehydration</keyword><keyword>vomiting</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1557-6272 (Electronic)&#xD;1557-6272 (Linking)</isbn><accession-num>23877938</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2013Overview of 4 systematic reviews of RCTs (3 cochrane reviews)++High and middle incomeIn and outpatients95 unique randomized controlled trials (N=12478) 87 randomized controlled trials included subjects < 18 years (N = 10 954)All studies included in the review were RCTsOral rehydrationIV rehydration--Length of stay (6 trials = 526 patients)Mean difference?1.20 (?2.38 to ?0.02)Complication (phlebitis)Risk difference?0.02 (?0.04 to ?0.01) ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2013</Year><RecNum>12408</RecNum><record><rec-number>12408</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Geary, D. F.</author></authors></contributors><auth-address>Sections of Emergency Medicine and Gastroenterology, Department of Paediatrics, Alberta Children&apos;s Hospital, Alberta, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Bolus fluid therapy and sodium homeostasis in paediatric gastroenteritis</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>215-22</pages><volume>49</volume><number>3</number><dates><year>2013</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1440-1754 (Electronic)&#xD;1034-4810 (Linking)</isbn><accession-num>23438262</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2013RCT+CanadaInpatients (ED)224 children (114 intervention group vs 110 control group) aged 3 months-11 years with dehydration (CDS>3) due to AGE and no response to ORT. Exclusion criteria: underlying chronic diseases.AdequateIV rehydration with 60 ml/kg 0.9% saline solution in 1 h followed by 5% dextrose in 0.9% saline at a maintenance rate.IV rehydration with 20 ml/kg 0.9% saline solution in 1 h followed by 5% dextrose in 0.9% saline at a maintenance rate.?YesChange in sodium levels (mEq/L) (60mL/Kg vs 20 mL/Kg)Mean±SD1.6±2.4 vs 0.9±2.2 (p=0.04)Large volume IV fluids does not promote the development oh hyponatraemiaSodium decrease ≥2 mEq/L from 0-4 hRates8/112 (7%) vs 17/105 (16%); (p=0.04)Sodium increase ≥2 mEq/L from 0-4 hRates59/112 (53%) vs 39/105 (37%); (p=0.02) ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2011</Year><RecNum>9148</RecNum><record><rec-number>9148</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Parkin, P. C.</author><author>Willan, A. R.</author><author>Schuh, S.</author></authors></contributors><auth-address>Division of Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada. stephen.freedman@sickkids.ca</auth-address><titles><title>Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial</title><secondary-title>BMJ</secondary-title></titles><periodical><full-title>Bmj</full-title></periodical><pages>d6976</pages><volume>343</volume><keywords><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/complications/ therapy</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous/methods</keyword><keyword>Intention to Treat Analysis</keyword><keyword>Length of Stay</keyword><keyword>Logistic Models</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year></dates><isbn>1756-1833 (Electronic)&#xD;0959-535X (Linking)</isbn><accession-num>22094316</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2011RCT+CanadaInpatients (ED)226 children (114 intervention group vs 112 control group) aged 3 months-11 years with dehydration (CDS>3) due to AGE and no response to ORT. Exclusion criteria: underlying chronic dieases.AdequateIV rehydration with 60 ml/kg 0.9% saline solution in 1 h followed by 5% dextrose in 0.9% saline at a maintenance rate.IV rehydration with 20 ml/kg 0.9% saline solution in 1 h followed by 5% dextrose in 0.9% saline at a maintenance rate.?YesRehydration (CDS<1) within 2 hours after treatmentabsolute difference (95%CI), NNT6.5% (CI 5.7% to 18.7%, p=0.32) NNT=15Children were moderately dehydrated. No difference in major outcomes between the two treatment arms was found. No relevant benefit of the rapid rehydration regimen. Time to discharge was slightly higher in rapid dehydration group although it did not achieve significance settled at 0.01 (6.3 h vs 5 h, p=0.03)Prolonged IV treatment absolute difference (95%CI)8.9% (CI 21% to -5%, p=0.19)Clinical dehydration scoresratep=0.96Time to dischargemean time (h)6.3 h vs 5 h (p=0.03)Physician comfort to discharge within 4 hours (Rapid vs standard group)5 point Likert scale 61(54) vs 74 (66), p=0.06 ADDIN EN.CITE <EndNote><Cite><Author>Nager</Author><Year>2010</Year><RecNum>9925</RecNum><record><rec-number>9925</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nager, A. L.</author><author>Wang, V. J.</author></authors></contributors><auth-address>Department of Pediatrics, Division of Emergency and Transport Medicine, Children&apos;s Hospital Los Angeles, University of Southern California and the Keck School of Medicine, Los Angeles, CA, USA. anager@chla.usc.edu</auth-address><titles><title>Comparison of ultrarapid and rapid intravenous hydration in pediatric patients with dehydration</title><secondary-title>Am J Emerg Med</secondary-title></titles><periodical><full-title>Am J Emerg Med</full-title></periodical><pages>123-9</pages><volume>28</volume><number>2</number><keywords><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Pilot Projects</keyword><keyword>Time Factors</keyword></keywords><dates><year>2010</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-8171 (Electronic)&#xD;0735-6757 (Linking)</isbn><accession-num>20159379</accession-num><urls></urls></record></Cite></EndNote>Nager AL, 2010RCT+USAInpatients (ED)88 children aged 3-36 months with moderate dehydration due to AGE. Exclusion criteria: electrolyte alteration, severe dehydration/shock, surgical conditions. AdequateIV rehydration with 50 ml/kg 0.9% saline in 1 h IV rehydration with 50 ml/kg 0.9% saline in 3 h88/88Nomean weight (g) gain (% of weight), rapid vs standard groupMean (%)474 (4.2%) vs 408 (3.8%), p=0.34Early discharge for cases (2 h vs 4 h). No difference between the two groups for all the outcomes.Return visitsFrequency (95%CI)15.6%(6.5 to 29.5) rapid vs 14% (5.3 to 28), p=0.99Electrolyte alterationsingle valuesNS difference ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2011</Year><RecNum>9518</RecNum><record><rec-number>9518</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Gouin, S.</author><author>Bhatt, M.</author><author>Black, K. J.</author><author>Johnson, D.</author><author>Guimont, C.</author><author>Joubert, G.</author><author>Porter, R.</author><author>Doan, Q.</author><author>van Wylick, R.</author><author>Schuh, S.</author><author>Atenafu, E.</author><author>Eltorky, M.</author><author>Cho, D.</author><author>Plint, A.</author></authors></contributors><auth-address>Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada. stephen.freedman@sickkids.ca</auth-address><titles><title>Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e287-95</pages><volume>127</volume><number>2</number><keywords><keyword>Age Factors</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/ economics/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Physician&apos;s Practice Patterns/ standards</keyword><keyword>Prospective Studies</keyword><keyword>Retrospective Studies</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>21262881</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2011Prospective cohort study+CanadaInpatients (ED)647 children 3-48 months admitted to 11 different EDs. Exclusion criteria: children already enrolled in other studies or families that were unavailable/unable to complete telephone follow-upNoNoNo 398/446 (89%) _proportion of children treated with IV rehydrationnumber and %149/647 (23%, range 6-66%)The use of IV rehydration varied dramatically among different institutions. The volume of IV fluids administered also varied according to site (P .003), with a range between 15 and 87 ml/kg).Frequency of readmission in patients undergoing IV therapy vs no IV therapyrate20% vs 9%, p=0.002Volume of IV fluidsrange and variation15 -87 ml/kg, p=0.003Predictors of IV rehydration:institution location OR (95%CI)3.0 (1.8 –5.0)bilious or bloody vomiting OR (95%CI)2.6 (1.2–5.5)previous physician visitOR (95%CI)1.7 (1.0–2.7)n° vomiting in 24 hOR (95%CI)1.1 (1.0 –1.1) per additional episode ADDIN EN.CITE <EndNote><Cite><Author>Moineau</Author><Year>1990</Year><RecNum>5092</RecNum><record><rec-number>5092</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moineau, G.</author><author>Newman, J.</author></authors></contributors><auth-address>Division of Emergency Services, Hospital for Sick Children, Toronto, Ontario, Canada.</auth-address><titles><title>Rapid intravenous rehydration in the pediatric emergency department</title><secondary-title>Pediatr Emerg Care</secondary-title></titles><periodical><full-title>Pediatr Emerg Care</full-title></periodical><pages>186-8</pages><volume>6</volume><number>3</number><keywords><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/diagnosis/etiology/ therapy</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Evaluation Studies</keyword><keyword>Female</keyword><keyword>Fluid Therapy/methods/ standards</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Pilot Projects</keyword><keyword>Questionnaires</keyword></keywords><dates><year>1990</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0749-5161 (Print)</isbn><accession-num>2216921</accession-num><urls></urls></record></Cite></EndNote>Moineau G, 1990Prospective Cohort study-CanadaInpatients (ED)17 children with isonatremic mild-to-moderate dehydration due to AGE, aged 1-6 yearsNo30 ml/kg 3.3% dextrose + 0.3% saline over 3 h_17/17no???No patients required hospitalization. Only one patient required a new course of rapid IV rehydration. ADDIN EN.CITE <EndNote><Cite><Author>Spandorfer</Author><Year>2005</Year><RecNum>496</RecNum><record><rec-number>496</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Spandorfer, P. R.</author><author>Alessandrini, E. A.</author><author>Joffe, M. D.</author><author>Localio, R.</author><author>Shaw, K. N.</author></authors></contributors><auth-address>Division of Emergency Medicine, Department of Pediatrics, Children&apos;s Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. spandorfer@email.chop.edu</auth-address><titles><title>Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>295-301</pages><volume>115</volume><number>2</number><keywords><keyword>Administration, Oral</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/complications/virology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Rehydration Solutions/ administration &amp; dosage</keyword><keyword>Single-Blind Method</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2005</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1098-4275 (Electronic)</isbn><accession-num>15687435</accession-num><urls></urls></record></Cite></EndNote>Spandorfer PR, 2005RCT+USAInpatients (ED)73 children (ORT 36 vs IV 37) aged < 3 years (mean age 15 m) with moderate dehydration (Gorelick score) secondary to AGE. Exclusion criteria: hypotention, diarrhea > 5 d, chronic illnesses, malnutritionAdequateOral rehydration with 50 ml/Kg (for dehydration score 3,4,5) or 75 ml/Kg (for score >6) hyposmolar ORS IV rehydration with 2 bolus of 20ml/Kg saline solution in 1 h. Then oral rehydration for 3 h 67/73 (3 ORT, 3 IVT)yesSuccess of treatment at 4 hours (defined as resolution of dehydration, weight gain, correction of urine output, absence of severe emesis) percentage of responders and risk differenceORT 55.6% vs IV 56.8%, RD= -1.2% [95%CI -24% to 21.6%]Initiating treatment with ORT was quicker than with IVT. ORT gained less weight than IVTTime to initiate therapytime and difference [95%CI]ORT 15 min vs IV 36 min, RD 21.2 [CI 10.3 to 32.1]Improvement of dehydration after 2 h% of responders and differenceORT 78.8% vs IV 80%, RD -1.2% [95%CI -20.5% to 18%]Hospitalization raterateORT 30.1% vs IV 48.7%, RD -18.1% [-40.1% to 4%] ADDIN EN.CITE <EndNote><Cite><Author>Phin</Author><Year>2003</Year><RecNum>1196</RecNum><record><rec-number>1196</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Phin, S. J.</author><author>McCaskill, M. E.</author><author>Browne, G. J.</author><author>Lam, L. T.</author></authors></contributors><auth-address>The Emergency Department, The Children&apos;s Hospital at Westmead, Westmead, New South Wales, Australia. susanp3@chw.edu.au</auth-address><titles><title>Clinical pathway using rapid rehydration for children with gastroenteritis</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>343-8</pages><volume>39</volume><number>5</number><keywords><keyword>Acute Disease</keyword><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Critical Pathways</keyword><keyword>Emergency Medical Services/ standards</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Gastroenteritis/ therapy</keyword><keyword>Hospitals, Pediatric</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>New South Wales</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2003</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1034-4810 (Print)</isbn><accession-num>12887663</accession-num><urls></urls></record></Cite></EndNote>Phin SJ, 2003Prospective study with historical controls+/-AustraliaInpatients (ED)145 children aged 6 months to 16 years, with AGE < 48h prospectively enrolled, 170 historic controls. Exclusion criteria: bloody stools, bilious vomiting, chronic medical conditions._Pathway including oral administration of fluids in 1 h followed by 20 ml/kg/h of 0.45% + 2.5% dextrose or Gastrolyte per NGT. Hystoric pathway, IV rehydration over 24 h and NGT rarely used.__discharge in 8 h (mild dehydration)rate61.3% vs 72.7%, p=NSrapid rehydration in children moderately dehydrated is effective in reducing admission rate and lengths of stay in EDdischarge in 8 h (moderate dehydration)rate44.2% vs 3.7%, p<0.001admission rate (mild dehydration)rate26.9% vs 25.9%, p=NSadmission rate (moderate dehydration)rate55.8% vs 96.3%, p<0.001procedure rate (mild dehydration)rate62.4% vs 23.9%, p<0.001procedure rate (moderate dehydration)rate94.2% vs 88.9%, p=NS ADDIN EN.CITE <EndNote><Cite><Author>Reid</Author><Year>1996</Year><RecNum>8656</RecNum><record><rec-number>8656</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Reid, S. R.</author><author>Bonadio, W. A.</author></authors></contributors><auth-address>Department of Pediatric Emergency Medicine, Children&apos;s Health Care-St Paul, Minnesota, USA.</auth-address><titles><title>Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis</title><secondary-title>Ann Emerg Med</secondary-title></titles><periodical><full-title>Ann Emerg Med</full-title></periodical><pages>318-23</pages><volume>28</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Emergencies</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/ complications</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Treatment Outcome</keyword><keyword>Vomiting/etiology/ therapy</keyword></keywords><dates><year>1996</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0196-0644 (Print)</isbn><accession-num>8780476</accession-num><urls></urls></record></Cite></EndNote>Reid SR, 1996Prospective cohort study?USAInpatients (ED)58 patients aged 6 months to 13 years (median age 22 months) with moderate dehydration _20-30 ml/kg isotonic cristalloid solution IV in 1-2 h followed by 30-90 ml of ORT ___???All patients demonstrated improvement of hydration degree. 28% did not tolerate ORT and were admitted to continue IVT. No complications were registered during IVT. AGE=acute gastroenteritis; ED=emergency department; IVT=Intravenous therapy; NGT=Nasogastric tube; ORS= Oral Rehydration Solution; ORT=Oral rehydration therapy; QoS=Quality of Study.Table 4.4.3. Treatment of hypernatremiaReferenceStudy typeQoSCountryIn/Out PatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>El-Bayoumi</Author><Year>2012</Year><RecNum>12417</RecNum><record><rec-number>12417</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>El-Bayoumi, M. A.</author><author>Abdelkader, A. M.</author><author>El-Assmy, M. M.</author><author>Alwakeel, A. A.</author><author>El-Tahan, H. M.</author></authors></contributors><auth-address>Pediatric Intensive Care Unit, Mansoura University Children Hospital, PO Box 63, Mansoura, Egypt. mabayoumi66@</auth-address><titles><title>Normal saline is a safe initial rehydration fluid in children with diarrhea-related hypernatremia</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>383-8</pages><volume>171</volume><number>2</number><keywords><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/mortality/ therapy</keyword><keyword>Diarrhea/ complications/mortality</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Humans</keyword><keyword>Hypernatremia/etiology/mortality/ therapy</keyword><keyword>Infant</keyword><keyword>Isotonic Solutions/therapeutic use</keyword><keyword>Male</keyword><keyword>Retrospective Studies</keyword><keyword>Sodium Chloride/ therapeutic use</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>21909623</accession-num><urls></urls></record></Cite></EndNote>El-Bayoumi MA, 2012Retrospective study+EgyptInpatients (PICU)48 children (mean age 21.8 m) with AGE and hypernatremic dehydration [Na]>150 (mean 163 mmol/L). Exclusion criteria: renal failure and diseases_No Intervention. Rehydration regimen: Fluid bolus of 20ml/kg 0.9% saline in 20 min followed by 48h infusion of 25-50 ml/kg/day of 0.9% saline in 5% dextrose. Velocity was 4 ml/kg/h first 10 Kg, 2 ml/kg/h 10-20 kg and 1ml/kg/h above 20 kg.___risk of mortality in children receiving > 40 ml/kg initial fluid bolusOR (95%CI)3.3 (1.5 to 7.2)Serum Na should be lowered slowly with rate of 0.5mEq/L/h. No difference in [Na] between children who presented seizures and not. risk of seizuresrate6.3%Hourly delta of Na 0-6 hmean delta (mEq/L/h)0.58 seizures vs 0.52 not (p=0.08)Hourly delta of Na 0-24 hmean delta (mEq/L/h)0.65 seizures vs 0.51 not (p=0.02)Hourly delta of Na 6-24 hmean delta (mEq/L/h)0.63 seizures vs 0.51 not (p=0.037) ADDIN EN.CITE <EndNote><Cite><Author>Robertson</Author><Year>2007</Year><RecNum>12472</RecNum><record><rec-number>12472</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Robertson, G.</author><author>Carrihill, M.</author><author>Hatherill, M.</author><author>Waggie, Z.</author><author>Reynolds, L.</author><author>Argent, A.</author></authors></contributors><auth-address>Paediatric Intensive Care Unit, Red Cross War Memorial Children&apos;s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. gillianr@ich.uct.ac.za</auth-address><titles><title>Relationship between fluid management, changes in serum sodium and outcome in hypernatraemia associated with gastroenteritis</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>291-6</pages><volume>43</volume><number>4</number><keywords><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/complications/ physiopathology</keyword><keyword>Humans</keyword><keyword>Hypernatremia/ therapy</keyword><keyword>Intensive Care Units, Pediatric</keyword><keyword>Rehydration Solutions/administration &amp; dosage</keyword><keyword>Retrospective Studies</keyword><keyword>Sodium/ analysis/blood</keyword><keyword>South Africa</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2007</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1034-4810 (Print)&#xD;1034-4810 (Linking)</isbn><accession-num>17444832</accession-num><urls></urls></record></Cite></EndNote>Robertson G, 2007Retrospective study?South AfricaInpatients (PICU)57 children with hypernatremia (Na>145, meadian 165 mmol/L)_No intervention: Maintenance according to Holliday-Segar + 50 ml/kg/day for moderately dehydrated children and 100 ml/kg/day for severely dehydrated with half Darrow's Dexstrose (5% dexstrose and 61 mEq/L Na)___Median rate of Na fallvelocity mmol/L/h0.6The majority of children in this study received a hypotonic IV infusion containing 61 mmol/L sodium. Although univariate analysis demonstrated a non-significant trend towards a more rapid fall in serum sodium in children who received solutions containing <61 mmol/L of sodium, this was not associated with a difference in outcome.Incidence of seizures (fall <0.6 group vs >0.6 mmol/L/h group)?p=0.43Incidence of adverse event (fall <0.6 group vs >0.6 mmol/L/h group)?p=0.31MortalityPercentage7% ADDIN EN.CITE <EndNote><Cite><Author>Sharifi</Author><Year>1985</Year><RecNum>6448</RecNum><record><rec-number>6448</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sharifi, J.</author><author>Ghavami, F.</author><author>Nowrouzi, Z.</author><author>Fouladvand, B.</author><author>Malek, M.</author><author>Rezaeian, M.</author><author>Emami, M.</author></authors></contributors><titles><title>Oral versus intravenous rehydration therapy in severe gastroenteritis</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>856-60</pages><volume>60</volume><number>9</number><keywords><keyword>Clinical Trials</keyword><keyword>Diarrhea, Infantile/therapy</keyword><keyword>Electrolytes/blood</keyword><keyword>Female</keyword><keyword>Fluid Therapy/adverse effects/ methods</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/blood/mortality/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Intubation, Gastrointestinal</keyword><keyword>Male</keyword></keywords><dates><year>1985</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1468-2044 (Electronic)</isbn><accession-num>3901934</accession-num><urls></urls></record></Cite></EndNote>Sharifi J, 1985RCT+/-IranInpatients (PICU)470 children aged 1-18 months admitted for severe AGENot appropriately describedNGT rehydration 40 ml/kg/h (max 400 ml/h) ORS for 6 h followed by maintenance per os or NGT with hypotonic ORSIV 20-30 ml/Kg/h Ringer Solution followed by maintenance fluids for 48 h?NoSeizures in hypernatremic patients treated with NGT vs IV rehydrationrate (%)2/34 (6%) vs 6/24 (25%), p=0.05ORT through NGT is successful in treating severe dehydration due to AGE and superior to IV therapy in reducing the complications associated with the treatment of hypernatremia. Methodological limitations: protocol, randomization and allocation concealment not described.AGE=acute gastroenteritis; NGT=Nasogastric tube; ORS=oral rehydration solution; QoS=Quality of Study.Table 4.5. When to discharge a child admitted because of gastroenteritisReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Patel</Author><Year>2009</Year><RecNum>10101</RecNum><record><rec-number>10101</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patel, B.</author><author>Kennebeck, S. S.</author><author>Caviness, A. C.</author><author>Macias, C. G.</author></authors></contributors><auth-address>Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. bxpatel@</auth-address><titles><title>Use of a discharge facilitator improves recall of emergency department discharge instructions for acute gastroenteritis</title><secondary-title>Pediatr Emerg Care</secondary-title></titles><periodical><full-title>Pediatr Emerg Care</full-title></periodical><pages>558-64</pages><volume>25</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Emergency Service, Hospital/ statistics &amp; numerical data</keyword><keyword>Gastroenteritis/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Intensive Care Units, Pediatric/ statistics &amp; numerical data</keyword><keyword>Parental Notification</keyword><keyword>Patient Discharge/ trends</keyword><keyword>Patient Education as Topic/methods</keyword><keyword>Retrospective Studies</keyword><keyword>United States</keyword></keywords><dates><year>2009</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1535-1815 (Electronic)&#xD;0749-5161 (Linking)</isbn><accession-num>19755887</accession-num><urls></urls></record></Cite></EndNote>Patel B, 2009Intervention study+/-USEDPatients aged 3 months to 18 years withNoWritten discharge instructions reinforced verbally by the bilingual discharge facilitatorStandard discharge group vs intervention group_NoRecall of 7 warning signs and symptoms assessed 24 to 48 hours after the ED visit (English speakers)Mean (95%CI)3.5 (3.26-3.78) vs 4.1 (3.83-4.43)Verbal reinforcement of written discharge instructions by a bilingual DF improves parental recall of discharge instructions for gastroenteritis.Recall of 7 warning signs and symptoms assessed 24 to 48 hours after the ED visit (Spanish speakers)Mean (95%CI)3 (2.67-3.36) vs 4.5 (4.18-4.88) ADDIN EN.CITE <EndNote><Cite><Author>Callery</Author><Year>2010</Year><RecNum>10096</RecNum><record><rec-number>10096</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Callery, P.</author><author>Kyle, R. G.</author><author>Campbell, M.</author><author>Banks, M.</author><author>Kirk, S.</author><author>Powell, P.</author></authors></contributors><auth-address>University of Manchester, Manchester, UK. peter.callery@manchester.ac.uk</auth-address><titles><title>Readmission in children&apos;s emergency care: an analysis of hospital episode statistics</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>341-6</pages><volume>95</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/therapy</keyword><keyword>Emergency Service, Hospital/ statistics &amp; numerical data</keyword><keyword>England</keyword><keyword>Female</keyword><keyword>Fever/therapy</keyword><keyword>Hospitalization/statistics &amp; numerical data</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Length of Stay/statistics &amp; numerical data</keyword><keyword>Male</keyword><keyword>Patient Discharge/statistics &amp; numerical data</keyword><keyword>Patient Readmission/ statistics &amp; numerical data</keyword><keyword>Respiration Disorders/therapy</keyword><keyword>Retrospective Studies</keyword><keyword>Time Factors</keyword><keyword>Urban Health/statistics &amp; numerical data</keyword></keywords><dates><year>2010</year><pub-dates><date>May</date></pub-dates></dates><isbn>1468-2044 (Electronic)&#xD;0003-9888 (Linking)</isbn><accession-num>19773219</accession-num><urls></urls></record></Cite></EndNote>Callery P, 2010Retrospective+UKInpatients (ED)All children under 15 years of age discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhea during 2005/2006 (n=20,354) or 2006/2007 (n=23,018)NoNoNoNoNoRate of readmission after same day dischargeThe total number of admissions to hospital in the year was associated with its readmission rate (Kendall's tau(b)=0.71, p=0.002). Variations between hospitals suggest that other factors can also affect readmission rates. OverallKendall's tau0,61, p=0,007Respiratory illnessesKendall's tau0,83, p<0,001Feverish illnessesKendall's tau0,50, p=0,023Acute diarrheaKendall's tau0,37, p=0,098DF= discharge facilitator; ED=emergency department; QoS=Quality of Study.Table 4.6. Can any therapeutic intervention reduce the length of hospital stay?ReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationInterventionComparisonFUITTOutcomes measuresRCT (n/N)Effect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Dupont</Author><Year>2009</Year><RecNum>10303</RecNum><record><rec-number>10303</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dupont, C.</author><author>Foo, J. L.</author><author>Garnier, P.</author><author>Moore, N.</author><author>Mathiex-Fortunet, H.</author><author>Salazar-Lindo, E.</author></authors></contributors><auth-address>Paris Descartes University, Cochin Saint-Vincent de Paul Hospital, Paris, France.</auth-address><titles><title>Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea</title><secondary-title>Clin Gastroenterol Hepatol</secondary-title></titles><periodical><full-title>Clin Gastroenterol Hepatol</full-title></periodical><pages>456-62</pages><volume>7</volume><number>4</number><keywords><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Feces</keyword><keyword>Gastrointestinal Agents/ administration &amp; dosage/ therapeutic use</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Malaysia</keyword><keyword>Male</keyword><keyword>Peru</keyword><keyword>Placebos/administration &amp; dosage</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Silicates/ administration &amp; dosage/ therapeutic use</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2009</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1542-7714 (Electronic)&#xD;1542-3565 (Linking)</isbn><accession-num>19268266</accession-num><urls></urls></record></Cite></EndNote>Dupont C, 2009RCT+Peru and MalaysiaOutpatients and InpatientsN=602 (1-36 mo)DB Smectite (6-12 g)Placebo.-YesDuration of diarrhea (hours)---Peru: lower 72-hour cumulative stool output (P=0.032); shorter duration of diarrhea (P=0.001).Malaysia: lower 72-hour stool output (P=0.007); shorter duration of diarrhea (P=0.001). ADDIN EN.CITE <EndNote><Cite><Author>Mujawar</Author><Year>2012</Year><RecNum>9406</RecNum><record><rec-number>9406</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mujawar, Q. M.</author><author>Naganoor, R.</author><author>Ali, M. D.</author><author>Malagi, N.</author><author>Thobbi, A. N.</author></authors></contributors><auth-address>Department of Pediatrics, Al Ameen Medical College, Bijapur 586108, Karnataka, India. quais_mujawar@</auth-address><titles><title>Efficacy of dioctahedral smectite in acute watery diarrhea in Indian children: a randomized clinical trial</title><secondary-title>J Trop Pediatr</secondary-title></titles><periodical><full-title>J Trop Pediatr</full-title></periodical><pages>63-7</pages><volume>58</volume><number>1</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ drug therapy</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>India</keyword><keyword>Male</keyword><keyword>Rehydration Solutions/ therapeutic use</keyword><keyword>Silicates/ therapeutic use</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1465-3664 (Electronic)&#xD;0142-6338 (Linking)</isbn><accession-num>21525141</accession-num><urls></urls></record></Cite></EndNote>Mujawar QM, 2012RCT+/- IndiaEDN=117 (2-5 y) with AGE.Single blindedDiosmectite (4.5 g/d for 5 d) no intervention--Duration of diarrhea---Shorter time for resolution of diarrhea (P<0.001). ADDIN EN.CITE <EndNote><Cite><Author>Lehert</Author><Year>2011</Year><RecNum>9416</RecNum><record><rec-number>9416</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lehert, P.</author><author>Cheron, G.</author><author>Calatayud, G. A.</author><author>Cezard, J. P.</author><author>Castrellon, P. G.</author><author>Garcia, J. M.</author><author>Santos, M.</author><author>Savitha, M. R.</author></authors></contributors><auth-address>Statistics Department, Faculty of Economics, FUCAM, Louvain Academy, Belgium. philippe.lehert@</auth-address><titles><title>Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis</title><secondary-title>Dig Liver Dis</secondary-title></titles><periodical><full-title>Dig Liver Dis</full-title></periodical><pages>707-13</pages><volume>43</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Antidiarrheals/ therapeutic use</keyword><keyword>Child</keyword><keyword>Combined Modality Therapy</keyword><keyword>Dehydration/etiology</keyword><keyword>Diarrhea/ drug therapy/etiology/therapy</keyword><keyword>Feces/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/complications/ drug therapy</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Rehydration Solutions/administration &amp; dosage/ therapeutic use</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Thiorphan/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Young Adult</keyword></keywords><dates><year>2011</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1878-3562 (Electronic)&#xD;1590-8658 (Linking)</isbn><accession-num>21514257</accession-num><urls></urls></record></Cite></EndNote>Lehert P, 2011MA ++high- or middle-income countriesOutpatients and Inpatients(9 RCTs, n=1384, 1 mo- 15 y)HeterogeneousRacecadotril (typically 1.5 mg/kg TID) placebo or equivalent (in particular, kaolin-pectin)--Patients with recovery defined as patients with a diarrhea duration of less than 2 days9HR (95%CI)2.04 (1.85 to 2.32)P<0.001Proven effective in reducing the duration of symptoms in children with AGE ADDIN EN.CITE <EndNote><Cite><Author>Macgillivray</Author><Year>2013</Year><RecNum>12489</RecNum><record><rec-number>12489</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Macgillivray, S.</author><author>Fahey, T.</author><author>McGuire, W.</author></authors></contributors><auth-address>Social Dimensions of Health Institute, University of Dundee, Airlie Place, Dundee, Tayside, UK, DD1 4HN.</auth-address><titles><title>Lactose avoidance for young children with acute diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD005433</pages><volume>10</volume><dates><year>2013</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>24173771</accession-num><urls></urls></record></Cite></EndNote>Macgillivray S, 2013MA++high- or middle-income countriesInpatients (1 outpatient)N= 2973 children aged two months to 59Months (29 RCT)HeterogeneousLactose-free milk, milk products, or foodstuffsLactose-containing milk, milk products, or foodstuffs-YesDuration of diarrhea (hours)16/29Mean difference (range)-17.77(25.32 to 10.21) vs (28.8 to 230)In young children with acute diarrhea who are not predominantly breast-fed, change to a lactose-free diet may result in earlier resolutionof acute diarrhea and reduce treatment failure. Diluting lactose-containing formulas may also have some bene?ts but further trials arerequired to have con?dence in this ?nding. However data were different in outpatients setting.Treatment failure18/29Relative effect(95% CI)0.52(0.39 to 0.68)Need for hospitalization1/29Relative effect(95% CI)0.79(0.09 to 6.65) ADDIN EN.CITE <EndNote><Cite><Author>Szajewska</Author><Year>2013</Year><RecNum>12474</RecNum><record><rec-number>12474</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Szajewska, H.</author><author>Skorka, A.</author><author>Ruszczynski, M.</author><author>Gieruszczak-Bialek, D.</author></authors></contributors><auth-address>Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland. hania@ipgate.pl</auth-address><titles><title>Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children--updated analysis of randomised controlled trials</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>467-76</pages><volume>38</volume><number>5</number><dates><year>2013</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>23841880</accession-num><urls></urls></record></Cite></EndNote>Szajewska H, 2013MA++High income (Europe) and low income In and outpatientsN= 2963patients (1603 in the experimental group and 1360 inthe control group) 15 studies5 unclearDailydoses of LGG ranging from 1.2 x 108 CFU to 2 x 1012 CFU in additionto rehydration therapyPlacebo (10)_YesDuration of diarrhea in days. (High dose and low dose).12/15Mean (95%CI)–1.11 [–1.91, –0.31] and –0.90 [–2.50, 0.69]LGG reduces the duration of diarrhea either in terms of days and hospitalizationDuration of diarrhea in days. Setting (Europe and non-Europe).11/15Mean (95%CI)–1.27 [–2.04, –0.49]and –0.87 [–1.81, 0.08]Hospitalization in days.4/15Mean (95%CI)–1.42 [–3.05, 0.21] ADDIN EN.CITE <EndNote><Cite><Author>Dinleyici</Author><Year>2012</Year><RecNum>12425</RecNum><record><rec-number>12425</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dinleyici, E. C.</author><author>Eren, M.</author><author>Ozen, M.</author><author>Yargic, Z. A.</author><author>Vandenplas, Y.</author></authors></contributors><auth-address>Eskisehir Osmangazi University, Department of Pediatric Infectious Disease and Intensive Care Unit, Eskisehir, Turkey. timboothtr@</auth-address><titles><title>Effectiveness and safety of Saccharomyces boulardii for acute infectious diarrhea</title><secondary-title>Expert Opin Biol Ther</secondary-title></titles><periodical><full-title>Expert Opin Biol Ther</full-title></periodical><pages>395-410</pages><volume>12</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Diarrhea/ microbiology/ therapy</keyword><keyword>Humans</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Saccharomyces/ physiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1744-7682 (Electronic)&#xD;1471-2598 (Linking)</isbn><accession-num>22335323</accession-num><urls></urls></record></Cite></EndNote>Dinleyici EC, 2012MA++high- or middle-income countriesInpatients13 RCTsHeterogeneousS boulardii Placebo or no interventionYesYesDuration of hospitalizationn=449Mean difference (95%CI) -0.84 (-1.14 to -0.54)administration of this probiotic strain may reduce the duration of hospitalization in inpatient children ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2013</Year><RecNum>12473</RecNum><record><rec-number>12473</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Ali, S.</author><author>Oleszczuk, M.</author><author>Gouin, S.</author><author>Hartling, L.</author></authors></contributors><auth-address>Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children&apos;s Hospital, Alberta Children&apos;s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries</title><secondary-title>Evid Based Child Health</secondary-title></titles><periodical><full-title>Evid Based Child Health</full-title></periodical><pages>1123-37</pages><volume>8</volume><number>4</number><keywords><keyword>anti?€?emetics</keyword><keyword>dehydration</keyword><keyword>diarrhoea</keyword><keyword>gastroenteritis</keyword><keyword>probiotics</keyword><keyword>rehydration</keyword><keyword>vomiting</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1557-6272 (Electronic)&#xD;1557-6272 (Linking)</isbn><accession-num>23877938</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2013Overview of 4 systematic reviews of RCTs (3 cochrane reviews)++High and middle incomeIn and outpatients95 unique randomized controlled trials (N=12478) 87 randomized controlled trials included subjects < 18 years (N = 10 954)All studies included in the review were RCTsProbioticsOral rehydration --Length of stay10 trials = 1932 patientsMean difference?1.12 (?1.16 to ?0.38) ADDIN EN.CITE <EndNote><Cite><Author>Piescik-Lech</Author><Year>2013</Year><RecNum>12423</RecNum><record><rec-number>12423</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Piescik-Lech, M.</author><author>Urbanska, M.</author><author>Szajewska, H.</author></authors></contributors><auth-address>Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-183, Warsaw, Poland.</auth-address><titles><title>Lactobacillus GG (LGG) and smectite versus LGG alone for acute gastroenteritis: a double-blind, randomized controlled trial</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>247-53</pages><volume>172</volume><number>2</number><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>23114849</accession-num><urls></urls></record></Cite></EndNote>Piescik-Lech M, 2013RCT+LGG (6 x 109) plus scmectiteLGG plus Placebo81/87YesDuration of intravenous therapy after randomization,days-Median (range)1 (0–1) vs 1 (0–3) p=0.02LGG plus smectite andLGG alone are equally effective for treating young childrenwith AGE. Combined use of the two interventions is notjustified.Duration of hospitalization after randomization,daysNo differenceVomiting, numberNo differenceNeed for hospitalization Number (%)No difference ADDIN EN.CITE <EndNote><Cite><Author>Rautenberg</Author><Year>2012</Year><RecNum>12457</RecNum><record><rec-number>12457</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rautenberg, T. A.</author><author>Zerwes, U.</author><author>Foerster, D.</author><author>Aultman, R.</author></authors></contributors><auth-address>Assessment in Medicine GmbH, Lorrach, Germany.</auth-address><titles><title>Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model</title><secondary-title>Clinicoecon Outcomes Res</secondary-title></titles><periodical><full-title>Clinicoecon Outcomes Res</full-title></periodical><pages>109-16</pages><volume>4</volume><keywords><keyword>Qaly</keyword><keyword>acute watery diarrhea</keyword><keyword>cost effectiveness</keyword><keyword>health economic model</keyword><keyword>infant</keyword><keyword>racecadotril</keyword></keywords><dates><year>2012</year></dates><isbn>1178-6981 (Electronic)&#xD;1178-6981 (Linking)</isbn><accession-num>22570557</accession-num><urls></urls></record></Cite></EndNote>Rautenberg TA, 2012cost utility analysis+UKOutpatients10 individual studies, 2 SR and 2 MA-Racecadotril + ORSORS--Total incremental QALY gainProbabilistic sensitivity analysis+0.0008Considering the best available evidence, racecadotril is cost effective in the treatment of AGE in childrenDrug costCost results?12.17 vs ?3.03 Primary care?51.12 vs ?62.64 Secondary care?40.20 vs ?416.82 Adverse events?0.35 vs ?0.46 Total mean cost per patient?103.84 vs ?482.95AGE=acute gastroenteritis; LGG= Lactobacillus rhamnosus GG; ORS=Oral rehydration solution; QALY=quality adjusted life year.TREATMENTTable 5.1. Rehydration Reference Intervention RandomizationAllocation concealment BlindingITT analysisPopulationMain results(experimental group vs. control group) ADDIN EN.CITE <EndNote><Cite><Author>Santucci</Author><Year>1998</Year><RecNum>12419</RecNum><record><rec-number>12419</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Santucci, K. A.</author><author>Anderson, A. C.</author><author>Lewander, W. J.</author><author>Linakis, J. G.</author></authors></contributors><auth-address>Department of Pediatric Emergency Medicine, Rhode Island Hospital, Providence, USA.</auth-address><titles><title>Frozen oral hydration as an alternative to conventional enteral fluids</title><secondary-title>Arch Pediatr Adolesc Med</secondary-title></titles><periodical><full-title>Arch Pediatr Adolesc Med</full-title></periodical><pages>142-6</pages><volume>152</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Over Studies</keyword><keyword>Dehydration/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Freezing</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Rehydration Solutions</keyword><keyword>Severity of Illness Index</keyword><keyword>Treatment Outcome</keyword><keyword>Vomiting</keyword></keywords><dates><year>1998</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1072-4710 (Print)&#xD;1072-4710 (Linking)</isbn><accession-num>9491039</accession-num><urls></urls></record></Cite></EndNote>Santucci KA, 1998Frozen solution (FS) (Revital-ICE, PTS Labs, Deerfield, Ill) vs conventional glucose electrolyte solution (CS)Prospective controlled crossover trial.N=91 (6 months to 13 years of age) children with AGE seen in pediatric ED Children with mild or moderate dehydration are more likely to tolerate FS than CS. Conventional solution failures crossed over to FS had a greater tolerance rate than the reverse. ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2012</Year><RecNum>12402</RecNum><record><rec-number>12402</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Keating, L. E.</author><author>Rumatir, M.</author><author>Schuh, S.</author></authors></contributors><auth-address>Divisions of aPediatric Emergency Medicine, Hospital for Sick Children Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Health care provider and caregiver preferences regarding nasogastric and intravenous rehydration</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>e1504-11</pages><volume>130</volume><number>6</number><keywords><keyword>Attitude of Health Personnel</keyword><keyword>Child, Preschool</keyword><keyword>Choice Behavior</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods/ psychology/utilization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infusions, Intravenous/ psychology/utilization</keyword><keyword>Inservice Training</keyword><keyword>Intubation, Gastrointestinal/ psychology/utilization</keyword><keyword>Male</keyword><keyword>Ontario</keyword><keyword>Parents/education/ psychology</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>23166337</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2012ORS with improved taste2 sucralose-sweetened ORSs vs. rice syrup solid ORS AdequateAdequateDB+N=66 (5-10 y), healthy childrenSucralose-sweetened ORSs significantly more palatable (P<0.001). ADDIN EN.CITE <EndNote><Cite><Author>Diez-Gandia</Author><Year>2010</Year><RecNum>10067</RecNum><record><rec-number>10067</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diez-Gandia, A.</author><author>Ajenjo, M. A.</author><author>Navalon, A. B.</author><author>Fernandez, R. B.</author><author>Sanz, A. B.</author><author>Diez-Domingo, J.</author></authors></contributors><auth-address>Centro de Salud Nazaret, Valencia, Espana.</auth-address><titles><title>[Palatability of oral rehydration solutions (ORS) in healthy 6 to 9 year-old children. A multicentre, randomised single blind clinical trial]</title><secondary-title>An Pediatr (Barc)</secondary-title></titles><periodical><full-title>An Pediatr (Barc)</full-title></periodical><pages>111-5</pages><volume>72</volume><number>2</number><keywords><keyword>Administration, Oral</keyword><keyword>Child</keyword><keyword>Diarrhea/ therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Single-Blind Method</keyword><keyword>Solutions</keyword><keyword>Taste</keyword></keywords><dates><year>2010</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1695-9531 (Electronic)&#xD;1695-4033 (Linking)</isbn><accession-num>19819203</accession-num><urls></urls></record></Cite></EndNote>Diez-Gandia A, 20104 ORSs (cola, strawberry, fruit, neutral)AdequateNoSingle-blindedYesN=116 (6-9 y), healthy childrenPreference for cola (rated as good or really good by 87.9%) and strawberry flavor (62.1%). ADDIN EN.CITE <EndNote><Cite><Author>Piescik-Lech</Author><Year>2012</Year><RecNum>8865</RecNum><record><rec-number>8865</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Piescik-Lech, M.</author><author>Szymanski, H.</author><author>Szajewska, H.</author></authors></contributors><auth-address>Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, Warsaw, Poland.</auth-address><titles><title>Efficacy and safety of a new apple-flavoured oral rehydration solution in children with acute gastroenteritis: a double-blind randomized controlled trial</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>e458-64</pages><volume>101</volume><number>10</number><keywords><keyword>Acute Disease</keyword><keyword>Administration, Oral</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology/prevention &amp; control/ therapy</keyword><keyword>Diarrhea/complications/ therapy</keyword><keyword>Female</keyword><keyword>Flavoring Agents/ standards</keyword><keyword>Gastroenteritis/complications/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Medication Adherence</keyword><keyword>Poland</keyword><keyword>Rehydration Solutions/administration &amp; dosage/ standards</keyword><keyword>Taste</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1651-2227 (Electronic)&#xD;0803-5253 (Linking)</isbn><accession-num>22860693</accession-num><urls></urls></record></Cite></EndNote>Piescik-Lech M, 2012Apple taste ORS vs. regular taste ORS AdequateAdequateDBNo (ACA)N=130 (4-48 mo) children with AGESimilar resolution of signs of dehydration (P=0.28), adequate weight gain (P=0.48), urine production at 24 h (P=0.95). ADDIN EN.CITE <EndNote><Cite><Author>Wadhwa</Author><Year>2011</Year><RecNum>9283</RecNum><record><rec-number>9283</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wadhwa, N.</author><author>Natchu, U. C.</author><author>Sommerfelt, H.</author><author>Strand, T. A.</author><author>Kapoor, V.</author><author>Saini, S.</author><author>Kainth, U. S.</author><author>Bhatnagar, S.</author></authors></contributors><auth-address>Centre for Diarrheal Diseases and Nutrition Research, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.</auth-address><titles><title>ORS containing zinc does not reduce duration or stool volume of acute diarrhea in hospitalized children</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>161-7</pages><volume>53</volume><number>2</number><keywords><keyword>Administration, Oral</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/etiology</keyword><keyword>Diarrhea/physiopathology/ therapy</keyword><keyword>Diarrhea, Infantile/physiopathology/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gluconates/administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>India</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Practice Guidelines as Topic</keyword><keyword>Rehydration Solutions/administration &amp; dosage/ therapeutic use</keyword><keyword>Severity of Illness Index</keyword><keyword>Time Factors</keyword><keyword>Trace Elements/administration &amp; dosage/ therapeutic use</keyword><keyword>World Health Organization</keyword><keyword>Zinc/administration &amp; dosage/ therapeutic use</keyword></keywords><dates><year>2011</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>21788757</accession-num><urls></urls></record></Cite></EndNote>Wadhwa N, 2011ORS with zinc ORS with vs. ORS without zinc (40 mg/L)AdequateAdequateDBYesN=500 (boys, 1-35 mo)Similar stool output (P=0.25); no difference or reduction in recovery time (HR 1.06, 95%CI 0.88 to 1.27). ADDIN EN.CITE <EndNote><Cite><Author>Passariello</Author><Year>2011</Year><RecNum>9688</RecNum><record><rec-number>9688</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Passariello, A.</author><author>Terrin, G.</author><author>De Marco, G.</author><author>Cecere, G.</author><author>Ruotolo, S.</author><author>Marino, A.</author><author>Cosenza, L.</author><author>Tardi, M.</author><author>Nocerino, R.</author><author>Berni Canani, R.</author></authors></contributors><auth-address>Department of Pediatrics, University of Naples Federico II, Naples, Italy.</auth-address><titles><title>Efficacy of a new hypotonic oral rehydration solution containing zinc and prebiotics in the treatment of childhood acute diarrhea: a randomized controlled trial</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>288-92 e1</pages><volume>158</volume><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Confidence Intervals</keyword><keyword>Diarrhea/diagnosis/mortality/ therapy</keyword><keyword>Diarrhea, Infantile/diagnosis/mortality/therapy</keyword><keyword>Female</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Hypotonic Solutions/therapeutic use</keyword><keyword>Infant</keyword><keyword>Italy</keyword><keyword>Kaplan-Meier Estimate</keyword><keyword>Male</keyword><keyword>Odds Ratio</keyword><keyword>Prebiotics</keyword><keyword>Prospective Studies</keyword><keyword>Reference Values</keyword><keyword>Rehydration Solutions/ therapeutic use</keyword><keyword>Risk Assessment</keyword><keyword>Severity of Illness Index</keyword><keyword>Single-Blind Method</keyword><keyword>Survival Rate</keyword><keyword>Treatment Outcome</keyword><keyword>Zinc/ therapeutic use</keyword></keywords><dates><year>2011</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1097-6833 (Electronic)&#xD;0022-3476 (Linking)</isbn><accession-num>20828714</accession-num><urls></urls></record></Cite></EndNote>Passariello A, 2011ORS with zinc and prebiotics ORS with zinc (1 mmol/L) & prebiotics vs. standard ORS AdequateAdequateSBYesN=119 (3-36 mo)Higher resolution of diarrhea at 72 h (P=0.01); reduced number of daily outputs at 24 h (P=0.002). ADDIN EN.CITE <EndNote><Cite><Author>Gregorio</Author><Year>2009</Year><RecNum>10255</RecNum><record><rec-number>10255</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gregorio, G. V.</author><author>Gonzales, M. L.</author><author>Dans, L. F.</author><author>Martinez, E. G.</author></authors></contributors><auth-address>Department of Pediatrics, College of Medicine-Philippine General Hospital, University of the Philippines, Taft Avenue, Manila, National Capital Region, Philippines, 1000. germana1@</auth-address><titles><title>Polymer-based oral rehydration solution for treating acute watery diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD006519</pages><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Child</keyword><keyword>Cholera/complications</keyword><keyword>Dehydration/etiology/ therapy</keyword><keyword>Diarrhea/complications/ therapy</keyword><keyword>Fluid Therapy/ methods</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Polymers/therapeutic use</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Rehydration Solutions/chemistry/ therapeutic use</keyword></keywords><dates><year>2009</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>19370638</accession-num><urls></urls></record></Cite></EndNote>Gregorio GV, 2009ORS with polymers Polymer-based ORS vs. glucose-based ORS Of the 34 trials, the methods used to generate the allocation sequence were adequate (computer-generated or random-numbers table) in 24 trials and unclear in the remaining 10 trials. Less than half of the trials (12) used an adequate method to conceal allocation. The method was unclear in the other 22 trials.Blinding of the participants, providers, and assessors was only done in three trials. Blinding was difficult or impossible in most trials because of the difference in the appearance of the ORS formulation after reconstitution.All but two trials included an adequate (> 90%) number of randomized participants in the analysis. The number was assessed as inadequate in two trials.MA (34 RCTs, n=4214; 27 RCTs in children)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). 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. ADDIN EN.CITE <EndNote><Cite><Author>Alam</Author><Year>2011</Year><RecNum>9298</RecNum><record><rec-number>9298</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Alam, N. H.</author><author>Raqib, R.</author><author>Ashraf, H.</author><author>Qadri, F.</author><author>Ahmed, S.</author><author>Zasloff, M.</author><author>Agerberth, B.</author><author>Salam, M. A.</author><author>Gyr, N.</author><author>Meier, R.</author></authors></contributors><auth-address>Clinical Sciences Division, ICDDR,B GPO Box 128, Dhaka 1000, Bangladesh. nhalam@</auth-address><titles><title>L-isoleucine-supplemented oral rehydration solution in the treatment of acute diarrhoea in children: a randomized controlled trial</title><secondary-title>J Health Popul Nutr</secondary-title></titles><periodical><full-title>J Health Popul Nutr</full-title></periodical><pages>183-90</pages><volume>29</volume><number>3</number><keywords><keyword>Analysis of Variance</keyword><keyword>Bangladesh</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ therapy</keyword><keyword>Enzyme-Linked Immunosorbent Assay</keyword><keyword>Feces/chemistry</keyword><keyword>Fluid Therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Isoleucine/ administration &amp; dosage</keyword><keyword>Male</keyword><keyword>Pilot Projects</keyword><keyword>Treatment Outcome</keyword><keyword>beta-Defensins/analysis</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1606-0997 (Print)&#xD;1606-0997 (Linking)</isbn><accession-num>21766553</accession-num><urls></urls></record></Cite></EndNote>Alam NH, 2011ORS with L-isoleucine ORS with vs. ORS without L-isoleucine (2 g/L)AdequateAdequateDBYesN=50 (boys, 6-36 mo)Reduced stool output on day 3 (P=0.03); smaller ORS intake on day 1 (P=0.04); similar duration of diarrhea (P=0.96).Abdulrhman et al. 2010 *ORS with honey ORS with vs. ORS without honeyN=100 (aged approx. 1.3 y)Reduction in vomiting (P<0.001) and diarrhea frequency (P<0.05).*Article not entirely accessed ADDIN EN.CITE <EndNote><Cite><Author>Esteban Carretero</Author><Year>2009</Year><RecNum>12461</RecNum><record><rec-number>12461</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Esteban Carretero, J.</author><author>Durban Reguera, F.</author><author>Lopez-Argueta Alvarez, S.</author><author>Lopez Montes, J.</author></authors></contributors><auth-address>Department of Gastroenterology, Hospital Torrecardenas, Almeria, Spain. jcestebanc@</auth-address><titles><title>A comparative analysis of response to vs. ORS + gelatin tannate pediatric patients with acute diarrhea</title><secondary-title>Rev Esp Enferm Dig</secondary-title></titles><periodical><full-title>Rev Esp Enferm Dig</full-title></periodical><pages>41-8</pages><volume>101</volume><number>1</number><keywords><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Diarrhea, Infantile/drug therapy</keyword><keyword>Electrolytes/ therapeutic use</keyword><keyword>Female</keyword><keyword>Gelatin</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Rehydration Solutions/ therapeutic use</keyword><keyword>Tannins/ therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1130-0108 (Print)&#xD;1130-0108 (Linking)</isbn><accession-num>19335032</accession-num><urls></urls></record></Cite></EndNote>Esteban Carretero J, 2009Gelatin tannate + ORSGelatin tannate + ORS vs ORS aloneNo – observational study--No239 children aged 3 months to 12 years with AGE (mean age 2.3 y)Stool decrease index ORS -0.1894 vs ORS + gelatin tannate -0.6023 (p<0.0001). The two groups of treatment differ at baseline with controls having more stools per day.AGE=acute gastroenteritis; ORS=Oral rehydration solution.Table 5.2. Nutritional managementReferenceType of StudyCountryIn/OutPatientsFU n/NPopulationInterventionComparisonOutcome measuresResults /Effect sizeRisk of BiasSource of FundingConclusions and CommentsRandomizationAllocation ConcealmentBlindingITT ADDIN EN.CITE <EndNote><Cite><Author>Gregorio</Author><Year>2011</Year><RecNum>9310</RecNum><record><rec-number>9310</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gregorio, G. V.</author><author>Dans, L. F.</author><author>Silvestre, M. A.</author></authors></contributors><auth-address>Department of Pediatrics, University of the Philippines College of Medicine, Philippine General Hospital, Taft Avenue, Manila, National Capital Region, Philippines, 1000.</auth-address><titles><title>Early versus Delayed Refeeding for Children with Acute Diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD007296</pages><number>7</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea/diet therapy/ therapy</keyword><keyword>Eating</keyword><keyword>Fluid Therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Time Factors</keyword></keywords><dates><year>2011</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>21735409</accession-num><urls></urls></record></Cite></EndNote>Gregorio GV, 2011Systematic review 16 countries Europe, USA, Africa, Asia10 trials Inpatient 2 trials OutpatientVariable12 trials, 1226 children AGE 0-5 years 724 early 502 late refeeding Early refeeding < 12h vs Late refeeding >12h Different feedingsEfficacy and Adverse effectsPrimary: Duration of diarrhea (7 Secondary: Stool output Weight gain IV fluids VomitingEarly vs Late Refeeding Duration of diarrhea 7/12 trials, 685 particip MD -6.90 h,CI -18.70 to 4.91 Unscheduled IV fluids 6/12 trials, 813 particip RR 0.87, CI 0.48 to -1.59 Stool output 24-48h 3/12 trials No difference Weight gain after 24h 3/12 trials No difference Vomiting 5/12, 456 participants RR 1.16, CI 0.72 to 1.86 All studies were RCT Yes – 2 studies Unclear -10 studiesNo – 11 studies Yes – 1 study, single blindingYes, for all outcomes – 5 trials Yes, for some outcomes – 7 trialsDifferent sources: Industry Academic WHOThe present meta-analysis did not provide evidence that early refeeding increases unscheduled use of IV fluids, episodes of vomiting, and development of persistent diarrhea. The results support existing practice of early refeeding during or after start of rehydration of patients. No conclusion could be made regarding the duration of diarrhea. ADDIN EN.CITE <EndNote><Cite><Author>Saneian</Author><Year>2012</Year><RecNum>12420</RecNum><record><rec-number>12420</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saneian, H.</author><author>Yaghini, O.</author><author>Modaresi, M.</author><author>Razmkhah, N.</author></authors></contributors><auth-address>Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran.</auth-address><titles><title>Lactose-free compared with lactose-containing formula in dietary management of acute childhood diarrhea</title><secondary-title>Iran J Pediatr</secondary-title></titles><periodical><full-title>Iran J Pediatr</full-title></periodical><pages>82-6</pages><volume>22</volume><number>1</number><keywords><keyword>Acute Diarrhea</keyword><keyword>Children</keyword><keyword>Lactose-Free Formula</keyword><keyword>Nutritional Management</keyword></keywords><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>2008-2150 (Electronic)&#xD;2008-2142 (Linking)</isbn><accession-num>23056864</accession-num><urls></urls></record></Cite></EndNote>Saneian H, 2012Prospective controlled trial Jan 2009 to Aug 2009Iran Outpatient 7 days 71 Children AGE Mean age 7.1±3.7m 1-24 months Formula fed Refeeding with Lactose-free vs Lactose containing formula Advantages of refeeding lactose-free formula Time to relief from diarrhea Diarrhea relief, days Lactose-free vs lactose 1.7±0.7 vs 2.6±0.7 95%CI 1.5 to 3.9, p<0.001 P<0.001 NoNANANot reportedIsfahan University Grant Early administration of lactose-free formula for formula fed children presenting with AGE can result in a more rapid relief of diarrhea However there were baseline differences between the groups (more days with diarrhea in the intervention group,p=0.047, more severe dehydration in the control, p=0.015) ADDIN EN.CITE <EndNote><Cite><Author>Rabbani</Author><Year>2009</Year><RecNum>10282</RecNum><record><rec-number>10282</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rabbani, G. H.</author><author>Ahmed, S.</author><author>Hossain, I.</author><author>Islam, R.</author><author>Marni, F.</author><author>Akhtar, M.</author><author>Majid, N.</author></authors></contributors><auth-address>Clinical Sciences Division and Physiology Laboratory, ICDDR,B: International Centre for Diarrhocal Disease Research, Dhaka, Bangladesh. rabbani@</auth-address><titles><title>Green banana reduces clinical severity of childhood shigellosis: a double-blind, randomized, controlled clinical trial</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>420-5</pages><volume>28</volume><number>5</number><keywords><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Carbohydrates/chemistry/ pharmacology</keyword><keyword>Child, Preschool</keyword><keyword>Ciprofloxacin/therapeutic use</keyword><keyword>Double-Blind Method</keyword><keyword>Dysentery, Bacillary/ therapy</keyword><keyword>Feces</keyword><keyword>Fluid Therapy</keyword><keyword>Fruit</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Injections, Intravenous</keyword><keyword>Musa/chemistry</keyword><keyword>Rehydration Solutions/administration &amp; dosage/therapeutic use</keyword><keyword>Time Factors</keyword></keywords><dates><year>2009</year><pub-dates><date>May</date></pub-dates></dates><isbn>0891-3668 (Print)&#xD;0891-3668 (Linking)</isbn><accession-num>19319017</accession-num><urls></urls></record></Cite></EndNote>Rabbani GH, 2009DB-RCT Sept 2004 to May 2005BangladeshInpatient73 Children Shigella AGE 6-60m All treated Ciprofloxacin Cooked green addition of banana (GB) 250g/L in children with ShigellosisEffect on diarrhea severity Success rate Effect of GB on stools: Reduction of volume Reduction of numbers/d Clearance of blood, mucus Reduction of fever Reduction of ORS volume GB vs control Clinical success 85.3% vs 66.7%, p=0.001 Clinical failure 14.7% vs 33.6%, p= 0.05 Yes- computer generated random numberYes-Investigators and patientsYes- Investigators and patientsNot reportedNone declaredGB diet improved clinical severity of childhood Shigellosis and can use as a simple and useful adjunct for dietary management of AGE Shigellosis ADDIN EN.CITE <EndNote><Cite><Author>Macgillivray</Author><Year>2013</Year><RecNum>12489</RecNum><record><rec-number>12489</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Macgillivray, S.</author><author>Fahey, T.</author><author>McGuire, W.</author></authors></contributors><auth-address>Social Dimensions of Health Institute, University of Dundee, Airlie Place, Dundee, Tayside, UK, DD1 4HN.</auth-address><titles><title>Lactose avoidance for young children with acute diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD005433</pages><volume>10</volume><dates><year>2013</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>24173771</accession-num><urls></urls></record></Cite></EndNote>Macgillivray S, 2013MA++high- or middle-income countriesInpatients (1 outpatient)N= 2973 children aged two months to 59 Months (29 RCT)Lactose-free milk, milk products, or foodstuffsLactose-containing milk, milk products, or foodstuffsDuration of diarrhea (hours)Mean difference (range): -17.77 (25.32 to 10.21) vs (28.8 to 230)YesHeterogeneousHeterogeneousYesUniversity of Dundee, UK. Hull York Medical School and NIHR Centre for Reviews and Dissemination, University of York, UK. Tenovus Scotland, UK.In young children with acute diarrhea who are not predominantly breast-fed, change to a lactose-free diet may result in earlier resolution of acute diarrhea and reduce treatment failure. Diluting lactose-containing formulas may also have some bene?ts but further trials are required to have con?dence in this ?nding. However data were different in outpatients setting.Treatment failureRelative effect(95% CI) 0.52(0.39 to 0.68)Need for hospitalizationRelative effect(95% CI) 0.79(0.09 to 6.65)AGE=acute gastroenteritis; NIHR=National Institute for Health Research; ORS=Oral rehydration solution.Table 5.3. Pharmacological TherapyReference Intervention RandomizationAllocation concealment BlindingITT analysisPopulationMain results(experimental group vs. control group) ADDIN EN.CITE <EndNote><Cite><Author>Freedman</Author><Year>2013</Year><RecNum>12473</RecNum><record><rec-number>12473</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Freedman, S. B.</author><author>Ali, S.</author><author>Oleszczuk, M.</author><author>Gouin, S.</author><author>Hartling, L.</author></authors></contributors><auth-address>Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children&apos;s Hospital, Alberta Children&apos;s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada. stephen.freedman@albertahealthservices.ca</auth-address><titles><title>Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries</title><secondary-title>Evid Based Child Health</secondary-title></titles><periodical><full-title>Evid Based Child Health</full-title></periodical><pages>1123-37</pages><volume>8</volume><number>4</number><keywords><keyword>anti?€?emetics</keyword><keyword>dehydration</keyword><keyword>diarrhoea</keyword><keyword>gastroenteritis</keyword><keyword>probiotics</keyword><keyword>rehydration</keyword><keyword>vomiting</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1557-6272 (Electronic)&#xD;1557-6272 (Linking)</isbn><accession-num>23877938</accession-num><urls></urls></record></Cite></EndNote>Freedman SB, 2013AntiemeticsOndansetron vs. placebo.All studies included in the review were RCTs95 unique randomized controlled trials (N=12478) 87 randomized controlled trials included subjects < 18 years (N = 10 954)Rate of admission to hospital (during ED stay) Relative Risk and NNT: 0.40 (0.19 to 0.83),NNT= 17 (13-60).Rate of IV rehydration (during ED stay) Relative Risk and NNT: 0.41 (0.29 to 0.59), NNT= 5 (4-8).Revisit rate ewlative risk: 0.09 (0.66 to 1.79) ADDIN EN.CITE <EndNote><Cite><Author>DeCamp</Author><Year>2008</Year><RecNum>10493</RecNum><record><rec-number>10493</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>DeCamp, L. R.</author><author>Byerley, J. S.</author><author>Doshi, N.</author><author>Steiner, M. J.</author></authors></contributors><auth-address>Pediatric Education Office, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Campus Box 7593, Chapel Hill, NC 27599, USA. lcr7n@alumni.virginia.edu</auth-address><titles><title>Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis</title><secondary-title>Arch Pediatr Adolesc Med</secondary-title></titles><periodical><full-title>Arch Pediatr Adolesc Med</full-title></periodical><pages>858-65</pages><volume>162</volume><number>9</number><keywords><keyword>Acute Disease</keyword><keyword>Antiemetics/ therapeutic use</keyword><keyword>Child</keyword><keyword>Gastroenteritis/complications/ drug therapy</keyword><keyword>Humans</keyword><keyword>Vomiting/ drug therapy/etiology</keyword></keywords><dates><year>2008</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1538-3628 (Electronic)&#xD;1072-4710 (Linking)</isbn><accession-num>18762604</accession-num><urls></urls></record></Cite></EndNote>DeCamp LR, 2008Ondansetron (oral: 2-8 mg; 1.6-4 mg; IV: 0.15-0.3 mg/kg) vs. placebo.Validity assessment was undertaken using two scales and a summary score was calculated. The two scales used were the Downs and Black checklist (maximum score 31) and the Delphi List (maximum score 9). Validity assessment was undertaken by two independent reviewers.MA (6 RCTs, n=745, 1 mo-12 y with vomiting and AGE)Reduced risk of persistent vomiting (RR 0.45, 95% CI 0.33 to 0.62; NNT 5); reduced need for IV therapy (RR 0.41, 95% CI 0.28 to 0.62, NNT 5); and reduced risk of immediate hospital admission (RR 0.52, 95% CI 0.27 to 0.95, NNT 14). Increased diarrheal episodes (3 RCTs, data not pooled). No effect on return to care (RR 1.34, 95% CI 0.77 to 2.35). ADDIN EN.CITE <EndNote><Cite><Author>Carter</Author><Year>2012</Year><RecNum>12421</RecNum><record><rec-number>12421</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carter, B.</author><author>Fedorowicz, Z.</author></authors></contributors><auth-address>North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.</auth-address><titles><title>Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework</title><secondary-title>BMJ Open</secondary-title></titles><periodical><full-title>BMJ Open</full-title></periodical><volume>2</volume><number>4</number><dates><year>2012</year></dates><isbn>2044-6055 (Electronic)</isbn><accession-num>22815462</accession-num><urls></urls></record></Cite></EndNote>Carter B, 2012Ondansetron (oral: 2-8 mg; IV: 0.15-0.3 mg/kg) vs. placebo Quality of the evidence (GRADE) as assessed by the authors – low to moderate (depending on the outcome) due to design limitation (risk of bias) and/or inconsistency due to possible change of effect of intervention over time and inconsistent follow up. MA (7 RCTs, n=760, <18 y with vomiting and AGE)Increased cessation of vomiting: (oral administration: 4 RCTs, RR 1.44, 95% CI 1.29 to 1.61; IV administration: 3 RCTs, RR 2.01, 95% CI 1.49 to 2.71; NNT 3). Reduced need for IV therapy: (oral administration, 4 RCTs, RR 0.41, 95% CI 0.29 to 0.59; NNT 5). Increased number of episodes of diarrhea (P<0.05). ADDIN EN.CITE <EndNote><Cite><Author>Gouin</Author><Year>2012</Year><RecNum>8949</RecNum><record><rec-number>8949</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gouin, S.</author><author>Vo, T. T.</author><author>Roy, M.</author><author>Lebel, D.</author><author>Gravel, J.</author></authors></contributors><auth-address>Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada. sergegouin@</auth-address><titles><title>Oral dimenhydrinate versus placebo in children with gastroenteritis: a randomized controlled trial</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>1050-5</pages><volume>129</volume><number>6</number><keywords><keyword>Administration, Oral</keyword><keyword>Antiemetics/ administration &amp; dosage/adverse effects</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dimenhydrinate/ administration &amp; dosage/adverse effects</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastroenteritis/ drug therapy/epidemiology</keyword><keyword>Headache/chemically induced</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Sleep Stages/drug effects/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Vomiting/ drug therapy/epidemiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1098-4275 (Electronic)&#xD;0031-4005 (Linking)</isbn><accession-num>22585774</accession-num><urls></urls></record></Cite></EndNote>Gouin S, 2012Dimenhydrinate (oral: dosage of 1 mg/kg per dose every 6 hours for 4 doses, with a maximum dose of 200 mg/day) vs placeboAdequateAdequateDBNoN=152 (76 cases and 76 controls)The prescription of oral dimenhydrinate did not significantly decrease the frequency of vomiting in children with acute gastroenteritis compared with placebo. ADDIN EN.CITE <EndNote><Cite><Author>Kita</Author><Year>2012</Year><RecNum>12459</RecNum><record><rec-number>12459</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kita, F.</author><author>Hinotsu, S.</author><author>Yorifuji, T.</author><author>Urushihara, H.</author><author>Shimakawa, T.</author><author>Kishida, K.</author><author>Wakazono, Y.</author><author>Yamauchi, E.</author><author>Sasaki, H.</author><author>Nakahata, T.</author><author>Kawakami, K.</author></authors></contributors><auth-address>Kyoto University, Kyoto, Japan.</auth-address><titles><title>Domperidone With ORT in the Treatment of Pediatric Acute Gastroenteritis in Japan: A Multicenter, Randomized Controlled Trial</title><secondary-title>Asia Pac J Public Health</secondary-title></titles><periodical><full-title>Asia Pac J Public Health</full-title></periodical><dates><year>2012</year><pub-dates><date>Jan 10</date></pub-dates></dates><isbn>1941-2479 (Electronic)&#xD;1010-5395 (Linking)</isbn><accession-num>22234829</accession-num><urls></urls></record></Cite></EndNote>Kita F, 2012Domperidone plus ORS vs ORS aloneAdequateN=56 (24controls) It appears that domperidone in combination with ORT in the treatment of acute gastroenteritis does not reduce vomiting in the early period. ADDIN EN.CITE <EndNote><Cite><Author>Lehert</Author><Year>2011</Year><RecNum>9416</RecNum><record><rec-number>9416</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lehert, P.</author><author>Cheron, G.</author><author>Calatayud, G. A.</author><author>Cezard, J. P.</author><author>Castrellon, P. G.</author><author>Garcia, J. M.</author><author>Santos, M.</author><author>Savitha, M. R.</author></authors></contributors><auth-address>Statistics Department, Faculty of Economics, FUCAM, Louvain Academy, Belgium. philippe.lehert@</auth-address><titles><title>Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis</title><secondary-title>Dig Liver Dis</secondary-title></titles><periodical><full-title>Dig Liver Dis</full-title></periodical><pages>707-13</pages><volume>43</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Antidiarrheals/ therapeutic use</keyword><keyword>Child</keyword><keyword>Combined Modality Therapy</keyword><keyword>Dehydration/etiology</keyword><keyword>Diarrhea/ drug therapy/etiology/therapy</keyword><keyword>Feces/virology</keyword><keyword>Female</keyword><keyword>Gastroenteritis/complications/ drug therapy</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Rehydration Solutions/administration &amp; dosage/ therapeutic use</keyword><keyword>Rotavirus/ isolation &amp; purification</keyword><keyword>Thiorphan/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Young Adult</keyword></keywords><dates><year>2011</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1878-3562 (Electronic)&#xD;1590-8658 (Linking)</isbn><accession-num>21514257</accession-num><urls></urls></record></Cite></EndNote>Lehert P, 2011 RacecadotrilRacecadotril (typically 1.5 mg/kg TID) vs. placebo or equivalent (in particular, kaolin-pectin)The methodological quality of each study was assessed usingChalmers scale (including sequence generation, allocation concealment, adequacy of blinding and handling of incomplete outcome data). Included studies were of various methodological quality. MA (9 RCTs, n=1384, 1 mo- 15 y)Higher proportion of patients with recovery defined as patients with a diarrhea duration of less than 2 days (HR 2.04, 95%CI 1.85 to 2.32; P<0.001).Reduced mean stool output in inpatients (HR 0.59, 95%CI 0.51 to 0.74; P<0.001).Reduced mean number of diarrheal stools in outpatients (HR 0.63, 95%CI 0.51 to 0.74; P<0.001). ADDIN EN.CITE <EndNote><Cite><Author>Dupont</Author><Year>2009</Year><RecNum>10285</RecNum><record><rec-number>10285</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dupont, C.</author><author>Vernisse, B.</author></authors></contributors><auth-address>Universite Paris Descartes, Service de Neonatologie, Hopital Saint-Vincent-de-Paul, Paris, France. christophe.dupont@svp.aphp.fr</auth-address><titles><title>Anti-diarrheal effects of diosmectite in the treatment of acute diarrhea in children: a review</title><secondary-title>Paediatr Drugs</secondary-title></titles><periodical><full-title>Paediatr Drugs</full-title></periodical><pages>89-99</pages><volume>11</volume><number>2</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Gastrointestinal Agents/ administration &amp; dosage/ therapeutic use</keyword><keyword>Humans</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Silicates/ administration &amp; dosage/ therapeutic use</keyword></keywords><dates><year>2009</year></dates><isbn>1174-5878 (Print)&#xD;1174-5878 (Linking)</isbn><accession-num>19301931</accession-num><urls></urls></record></Cite></EndNote>Dupont C, 2009SmectiteSmectite (6-12 g) vs. placebo.AdequateUnclearDBPer protocol analysisN=602 (1-36 mo)Peru: lower 72-hour cumulative stool output (P=0.032); shorter duration of diarrhea (P=0.001).Malaysia: lower 72-hour stool output (P=0.007); shorter duration of diarrhea (P=0.001). ADDIN EN.CITE <EndNote><Cite><Author>Mujawar</Author><Year>2012</Year><RecNum>9406</RecNum><record><rec-number>9406</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mujawar, Q. M.</author><author>Naganoor, R.</author><author>Ali, M. D.</author><author>Malagi, N.</author><author>Thobbi, A. N.</author></authors></contributors><auth-address>Department of Pediatrics, Al Ameen Medical College, Bijapur 586108, Karnataka, India. quais_mujawar@</auth-address><titles><title>Efficacy of dioctahedral smectite in acute watery diarrhea in Indian children: a randomized clinical trial</title><secondary-title>J Trop Pediatr</secondary-title></titles><periodical><full-title>J Trop Pediatr</full-title></periodical><pages>63-7</pages><volume>58</volume><number>1</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Dehydration/ drug therapy</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>India</keyword><keyword>Male</keyword><keyword>Rehydration Solutions/ therapeutic use</keyword><keyword>Silicates/ therapeutic use</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1465-3664 (Electronic)&#xD;0142-6338 (Linking)</isbn><accession-num>21525141</accession-num><urls></urls></record></Cite></EndNote>Mujawar QM, 2012Diosmectite (4.5 g/d for 5 d) vs. no intervention AdequateUnclearSingle blinded?N=117 (2-5 y) with AGE.Shorter time for resolution of diarrhea (P<0.001). ADDIN EN.CITE <EndNote><Cite><Author>Patro</Author><Year>2008</Year><RecNum>10361</RecNum><record><rec-number>10361</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patro, B.</author><author>Golicki, D.</author><author>Szajewska, H.</author></authors></contributors><auth-address>The 2nd Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland.</auth-address><titles><title>Meta-analysis: zinc supplementation for acute gastroenteritis in children</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>713-23</pages><volume>28</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Child, Preschool</keyword><keyword>Databases, Bibliographic</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Dietary Supplements</keyword><keyword>Europe/epidemiology</keyword><keyword>Gastroenteritis/ drug therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Severity of Illness Index</keyword><keyword>Time Factors</keyword><keyword>Trace Elements/deficiency/ therapeutic use</keyword><keyword>Treatment Outcome</keyword><keyword>Zinc/deficiency/ therapeutic use</keyword></keywords><dates><year>2008</year><pub-dates><date>Sep 15</date></pub-dates></dates><isbn>0269-2813 (Print)&#xD;0269-2813 (Linking)</isbn><accession-num>19145727</accession-num><urls></urls></record></Cite></EndNote>Patro B, 2008ZincZinc vs. placebo or zinc in other dose or no interventionKey criteria assessed included the adequacy of allocation concealment, blinding (investigators, participants, outcome assessors and data analysts), ITT analysis and completeness of follow‐up. Study quality was reported to be high.MA (18 RCTs, n=11,180 with AGE, <5y)Reduced duration of diarrhea (13 RCTs, n=5643, MD -0.7 day; 95% CI -0.97 to -0.40).Reduced the risk of diarrhea lasting >7days (8 RCTs, n=5769, RR 0.71; 95% CI 0.53–0.96).Increased chance of vomiting (5 RCTs, n=3156, RR 1.2; 95% CI 1.05–1.4). ADDIN EN.CITE <EndNote><Cite><Author>Patel</Author><Year>2010</Year><RecNum>9842</RecNum><record><rec-number>9842</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patel, A.</author><author>Mamtani, M.</author><author>Dibley, M. J.</author><author>Badhoniya, N.</author><author>Kulkarni, H.</author></authors></contributors><auth-address>Lata Medical Research Foundation, Nagpur, India.</auth-address><titles><title>Therapeutic value of zinc supplementation in acute and persistent diarrhea: a systematic review</title><secondary-title>PLoS One</secondary-title></titles><periodical><full-title>PLoS One</full-title></periodical><pages>e10386</pages><volume>5</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Diarrhea/ drug therapy/epidemiology/etiology</keyword><keyword>Dietary Supplements</keyword><keyword>Humans</keyword><keyword>Treatment Outcome</keyword><keyword>Zinc/administration &amp; dosage/deficiency/ therapeutic use</keyword></keywords><dates><year>2010</year></dates><isbn>1932-6203 (Electronic)&#xD;1932-6203 (Linking)</isbn><accession-num>20442848</accession-num><urls></urls></record></Cite></EndNote>Patel A, 2010Zinc vs. placebo or no interventionNo report of the formal assessment of the risk of bias in included trials. MA (26 RCTs, n=20,480)Shorter duration of diarrhea (19 RCTs; n=8957; shortened by 19.7%; 95% CI 11.9% to 27.4%).Increased chance of vomiting (10 RCTs; n=6779; OR 2.13; 95%CI 1.37-3.31).No effect on stool frequency and stool output. ADDIN EN.CITE <EndNote><Cite><Author>Lazzerini</Author><Year>2012</Year><RecNum>12496</RecNum><record><rec-number>12496</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lazzerini, M.</author><author>Ronfani, L.</author></authors></contributors><auth-address>Unit for Health Services Research and International Health,WHO Collaborating Centre forMaternal and ChildHealth, Institute forMaternal and Child Health, Trieste, Italy. lazzerini@burlo.trieste.it.</auth-address><titles><title>Oral zinc for treating diarrhoea in children</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD005436</pages><volume>6</volume><keywords><keyword>Acute Disease</keyword><keyword>Age Factors</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy/mortality</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Time Factors</keyword><keyword>Trace Elements/adverse effects/ therapeutic use</keyword><keyword>Zinc/adverse effects/deficiency/ therapeutic use</keyword></keywords><dates><year>2012</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>22696352</accession-num><urls></urls></record></Cite></EndNote>Lazzerini M, 2012Zinc vs. placebo Quality of the evidence (GRADE) as assessed by the authors – very low (death; hospitalization); low (duration of diarrhea all trials); moderate (diarrhea on day 7); high (duration of diarrhea in trials limited to children with signs of moderate malnutrition; adverse events). MA (24 RCTs, n=9128, age 1 mo- 5 y)Reduced duration of diarrhea in children > 6 mo (MD -10 h; 95%CI -21.12 to 0.25).Reduced duration of diarrhea in malnourished children (MD -27 h; 95%CI -14.7 to -39). ADDIN EN.CITE <EndNote><Cite><Author>Allen</Author><Year>2010</Year><RecNum>9611</RecNum><record><rec-number>9611</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allen, S. J.</author><author>Martinez, E. G.</author><author>Gregorio, G. V.</author><author>Dans, L. F.</author></authors></contributors><auth-address>School of Medicine, Swansea University, Room 314, The Grove Building, Singleton Park, Swansea, West Glamorgan, UK, SA2 8PP.</auth-address><titles><title>Probiotics for treating acute infectious diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD003048</pages><number>11</number><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/parasitology/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Probiotics/ therapeutic use</keyword></keywords><dates><year>2010</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>21069673</accession-num><urls></urls></record></Cite></EndNote>Allen SJ, 2010Probiotics (as a group) Probiotics vs. placebo or no intervention. The methodological quality (i.e. generation of allocation sequence, allocation concealment, blinding, and loss to follow) varied considerably. Twenty-three studies were considered adequatefor generation of the allocation sequence, 15 for concealment of allocation, 35 for blinding and 45 for loss to follow up. Ten studies were adequate for all of the four methodological quality assessmentparameters and five studies were inadequate for all four parameters.MA (63 RCTs, n=8014)Reduced duration of diarrhea (35 RCTs, n=4555; MD -25 h; 95% CI 16 to 34); reduced risk of diarrhea lasting ≥4 days (29 RCTs, n=2853, RR 0.41, 95% CI 0.32 to 0.53). ADDIN EN.CITE <EndNote><Cite><Author>Allen</Author><Year>2010</Year><RecNum>9611</RecNum><record><rec-number>9611</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allen, S. J.</author><author>Martinez, E. G.</author><author>Gregorio, G. V.</author><author>Dans, L. F.</author></authors></contributors><auth-address>School of Medicine, Swansea University, Room 314, The Grove Building, Singleton Park, Swansea, West Glamorgan, UK, SA2 8PP.</auth-address><titles><title>Probiotics for treating acute infectious diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD003048</pages><number>11</number><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/parasitology/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Probiotics/ therapeutic use</keyword></keywords><dates><year>2010</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>21069673</accession-num><urls></urls></record></Cite></EndNote>Allen SJ, 2010Lactobacillus GGLactobacillus GG vs. placebo or no intervention See aboveMA, 11 RCTs, n=2072Reduced duration of diarrhea (MD -26.69; 95%CI -40.5 to -12.88), mean stool frequency on day 2 (6 RCTs, n=1335; MD -0.76, 95%CI -1.32 to -0.2), and the risk of diarrhea lasting ≥4 days (4 RCTs, n=572; RR 0.59, 95%CI 0.40 to 0.87). ADDIN EN.CITE <EndNote><Cite><Author>Szajewska</Author><Year>2013</Year><RecNum>12474</RecNum><record><rec-number>12474</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Szajewska, H.</author><author>Skorka, A.</author><author>Ruszczynski, M.</author><author>Gieruszczak-Bialek, D.</author></authors></contributors><auth-address>Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland. hania@ipgate.pl</auth-address><titles><title>Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children--updated analysis of randomised controlled trials</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>467-76</pages><volume>38</volume><number>5</number><dates><year>2013</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>23841880</accession-num><urls></urls></record></Cite></EndNote>Szajewska H, 2013Lactobacillus GGDaily doses of LGG ranging from 1.2 x 108 CFU to 2 x 1012 CFU in addition to rehydration therapy vs PlaceboThe methodological quality of the studies (generation of randomization, allocation concealment, blinding, ITT analysis, and completness to follow-up) varied. MA, N= 2963patients (1603 in the experimental group and 1360 inthe control group) 15 studiesLactobacillus GG reduces the duration of diarrhea either in terms of days and hospitalization ADDIN EN.CITE <EndNote><Cite><Author>Allen</Author><Year>2010</Year><RecNum>9611</RecNum><record><rec-number>9611</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allen, S. J.</author><author>Martinez, E. G.</author><author>Gregorio, G. V.</author><author>Dans, L. F.</author></authors></contributors><auth-address>School of Medicine, Swansea University, Room 314, The Grove Building, Singleton Park, Swansea, West Glamorgan, UK, SA2 8PP.</auth-address><titles><title>Probiotics for treating acute infectious diarrhoea</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD003048</pages><number>11</number><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/parasitology/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Probiotics/ therapeutic use</keyword></keywords><dates><year>2010</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>21069673</accession-num><urls></urls></record></Cite></EndNote>Allen SJ, 2010Saccharomyces boulardiiS boulardii vs. placebo or no intervention See above MA (10 RCTs, n=860)Reduced risk of diarrhea lasting ≥4 d (6 RCTs, n=606, RR 0.37; 95% CI 0.21 to 0.65; NNT 3, 95% CI 2-3). ADDIN EN.CITE <EndNote><Cite><Author>Szajewska</Author><Year>2009</Year><RecNum>10082</RecNum><record><rec-number>10082</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Szajewska, H.</author><author>Skorka, A.</author></authors></contributors><titles><title>Saccharomyces boulardii for treating acute gastroenteritis in children: updated meta-analysis of randomized controlled trials</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>960-1</pages><volume>30</volume><number>9</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Gastroenteritis/ diet therapy</keyword><keyword>Humans</keyword><keyword>Meta-Analysis as Topic</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Saccharomyces</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov 1</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>19807726</accession-num><urls></urls></record></Cite></EndNote>Szajewska H, 2009S boulardii vs. placebo or no intervention The methodological quality of the trials varied. MA (9 RCTs, n=1117)Reduced duration of diarrhea (7 RCTs, n=944, MD 1.08 d, 95%CI -1.64 to -0.53 ADDIN EN.CITE <EndNote><Cite><Author>Dinleyici</Author><Year>2012</Year><RecNum>12425</RecNum><record><rec-number>12425</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dinleyici, E. C.</author><author>Eren, M.</author><author>Ozen, M.</author><author>Yargic, Z. A.</author><author>Vandenplas, Y.</author></authors></contributors><auth-address>Eskisehir Osmangazi University, Department of Pediatric Infectious Disease and Intensive Care Unit, Eskisehir, Turkey. timboothtr@</auth-address><titles><title>Effectiveness and safety of Saccharomyces boulardii for acute infectious diarrhea</title><secondary-title>Expert Opin Biol Ther</secondary-title></titles><periodical><full-title>Expert Opin Biol Ther</full-title></periodical><pages>395-410</pages><volume>12</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Diarrhea/ microbiology/ therapy</keyword><keyword>Humans</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Saccharomyces/ physiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1744-7682 (Electronic)&#xD;1471-2598 (Linking)</isbn><accession-num>22335323</accession-num><urls></urls></record></Cite></EndNote>Dinleyici EC, 2012S boulardii vs. placebo or no intervention All included trials had a number of methodological limitations; however, >80% of the studies have follow-up and ITT analysis. Small sample sizes in some of the trials. MA (13 RCTs)Reduced duration of diarrhea (11 RCTs, n=1306; MD -0.99 d (-1.4 to -0.58).Diarrhea on day 3 (9 RCTs, n= 1128; RR 0.52; 95% CI 0.42 to 0.65)Duration of hospitalization (n=449; MD -0.84 d (-1.14 to -0.54) ADDIN EN.CITE <EndNote><Cite><Author>Riaz</Author><Year>2012</Year><RecNum>9182</RecNum><record><rec-number>9182</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Riaz, M.</author><author>Alam, S.</author><author>Malik, A.</author><author>Ali, S. M.</author></authors></contributors><auth-address>Department of Pediatrics, Jawaharlal Nehru Medical College, AMU, Aligarh, UP, India.</auth-address><titles><title>Efficacy and safety of Saccharomyces boulardii in acute childhood diarrhea: a double blind randomised controlled trial</title><secondary-title>Indian J Pediatr</secondary-title></titles><periodical><full-title>Indian J Pediatr</full-title></periodical><pages>478-82</pages><volume>79</volume><number>4</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Drug Administration Schedule</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>India</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Probiotics/adverse effects/ therapeutic use</keyword><keyword>Saccharomyces</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0973-7693 (Electronic)&#xD;0019-5456 (Linking)</isbn><accession-num>21997865</accession-num><urls></urls></record></Cite></EndNote>Riaz M, 2012S boulardii vs. placebo UnclearUnclearDBNo (ACA)N=108 (3-59 mo)Reduced duration of diarrhea (P=0.03)Shorter time of appearance of first semi- formed stool (P=0.008). ADDIN EN.CITE <EndNote><Cite><Author>Correa</Author><Year>2011</Year><RecNum>9312</RecNum><record><rec-number>9312</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Correa, N. B.</author><author>Penna, F. J.</author><author>Lima, F. M.</author><author>Nicoli, J. R.</author><author>Filho, L. A.</author></authors></contributors><auth-address>Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.</auth-address><titles><title>Treatment of acute diarrhea with Saccharomyces boulardii in infants</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>497-501</pages><volume>53</volume><number>5</number><keywords><keyword>Acute Disease</keyword><keyword>Administration, Oral</keyword><keyword>Brazil</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Feces/chemistry/virology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Probiotics/ administration &amp; dosage</keyword><keyword>Rotavirus/isolation &amp; purification</keyword><keyword>Saccharomyces</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>21734600</accession-num><urls></urls></record></Cite></EndNote>Correa NB, 2011S boulardii vs. placeboAdequateUnclearDBNo(ACA)N=176 (6-48 mo)Reduced frequency of diarrhea at day 2 (P<0.01).Reduced frequency of diarrhea at day 3 (P<0.01). ADDIN EN.CITE <EndNote><Cite><Author>Chmielewska</Author><Year>2008</Year><RecNum>12426</RecNum><record><rec-number>12426</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chmielewska, A</author><author><style face="normal" font="default" size="100%">Ruszczy</style><style face="normal" font="default" charset="134" size="100%">ński</style><style face="normal" font="default" size="100%">,</style><style face="normal" font="default" charset="134" size="100%"> M</style></author><author><style face="normal" font="default" charset="134" size="100%">Szajewska</style><style face="normal" font="default" size="100%">,</style><style face="normal" font="default" charset="134" size="100%"> H </style><style face="normal" font="default" charset="238" size="100%"> </style></author></authors></contributors><titles><title><style face="normal" font="default" charset="134" size="100%">Lactobacillus reuteri strain ATCC 55730 for the treatment of acute infectious diarrhoea in children: a meta-analysis of randomized controlled trials</style></title><secondary-title><style face="normal" font="default" charset="134" size="100%">Pediatria Wsp</style><style face="normal" font="default" size="100%">ó</style><style face="normal" font="default" charset="238" size="100%">?czesna. Gastroenterologia, Hepatologia i ?ywienie Dziecka</style></secondary-title></titles><periodical><full-title>Pediatria Wspó?czesna. Gastroenterologia, Hepatologia i ?ywienie Dziecka</full-title></periodical><pages>33-37</pages><volume><style face="normal" font="default" charset="238" size="100%">10</style></volume><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>Chmielewska A, 2008L. reuteri ATCC 5573L. reuteri ATCC 5573 vs. placebo The methodological quality of the studies (generation of randomization, allocation concealment, blinding, ITT analysis, and completeness to follow-up) varied. MA (2 RCTs, n=106)Reduced duration of diarrhea (MD -25 h; 95%CI-39.4 to -10.9).Reduced risk of diarrhea on day 1 (RR 0.88; 95%CI 0.8 to 0.99), on day 2 (RR 0.6; 95%CI 0.4 to 0.8), on day 3 (RR 0.45; 95%CI 0.3 to 0.8), and on day 4 (RR 0.36; 95%CI 0.1 to 0.7). ADDIN EN.CITE <EndNote><Cite><Author>Francavilla</Author><Year>2012</Year><RecNum>8925</RecNum><record><rec-number>8925</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francavilla, R.</author><author>Lionetti, E.</author><author>Castellaneta, S.</author><author>Ciruzzi, F.</author><author>Indrio, F.</author><author>Masciale, A.</author><author>Fontana, C.</author><author>La Rosa, M. M.</author><author>Cavallo, L.</author><author>Francavilla, A.</author></authors></contributors><auth-address>Department of Biomedicina dell&apos;Eta Evolutiva, University of Bari, Piazza Giulio Cesare 11, Bari, Italy. rfrancavilla@</auth-address><titles><title>Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea--a double-blind study</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>363-9</pages><volume>36</volume><number>4</number><keywords><keyword>Child, Preschool</keyword><keyword>Dehydration/physiopathology/ therapy</keyword><keyword>Diarrhea/physiopathology/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Gastroenteritis/physiopathology/ therapy</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Italy</keyword><keyword>Lactobacillus reuteri/ physiology</keyword><keyword>Male</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Recurrence</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>22680836</accession-num><urls></urls></record></Cite></EndNote>Francavilla R, 2012L. reuteri DSM 17938L. reuteri DSM 17938 vs. placeboAdequateUnclearDBYesN=74 (6-36 mo)Reduced duration of watery diarrhea (P<0.03).Smaller number of patients with persistent diarrhea on day 2 (P<0.01) and on day 3 (P<0.03).Lower relapse rate (P<0.03). ADDIN EN.CITE <EndNote><Cite><Author>Piescik-Lech</Author><Year>2013</Year><RecNum>12423</RecNum><record><rec-number>12423</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Piescik-Lech, M.</author><author>Urbanska, M.</author><author>Szajewska, H.</author></authors></contributors><auth-address>Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-183, Warsaw, Poland.</auth-address><titles><title>Lactobacillus GG (LGG) and smectite versus LGG alone for acute gastroenteritis: a double-blind, randomized controlled trial</title><secondary-title>Eur J Pediatr</secondary-title></titles><periodical><full-title>Eur J Pediatr</full-title></periodical><pages>247-53</pages><volume>172</volume><number>2</number><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1432-1076 (Electronic)&#xD;0340-6199 (Linking)</isbn><accession-num>23114849</accession-num><urls></urls></record></Cite></EndNote>Piescik-Lech M, 2013LGG (6 x 109) plus scmectiteLGG (6 x 109) plus scmectite vs LGG plus PlaceboAdequateAdequateDBYesN=88 children (44 treated and 44 controls) aged 4 to 60 monthsLGG plus smectite andLGG alone are equally effective for treating young childrenwith AGE. Combined use of the two interventions is notjustified. ADDIN EN.CITE <EndNote><Cite><Author>Vandenplas</Author><Year>2011</Year><RecNum>9234</RecNum><record><rec-number>9234</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vandenplas, Y.</author><author>De Hert, S. G.</author></authors></contributors><auth-address>Universitair KinderZiekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. yvan.vandenplas@uzbrussel.be</auth-address><titles><title>Randomised clinical trial: the synbiotic food supplement Probiotical vs. placebo for acute gastroenteritis in children</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>862-7</pages><volume>34</volume><number>8</number><keywords><keyword>Adolescent</keyword><keyword>Belgium</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/microbiology/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Feces</keyword><keyword>Female</keyword><keyword>Gastroenteritis/microbiology/ therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Severity of Illness Index</keyword><keyword>Synbiotics</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>21899583</accession-num><urls></urls></record></Cite></EndNote>Vandenplas Y, 2011Synbiotics5 probiotic strains & fructooligosaccharides vs. placeboAdequateAdequateDBYesN=111 (1-186 mo)Reduced duration of diarrhea [3 days (IQR 2-4) vs. 4 days (IQR 4-5); P<0.005]. ADDIN EN.CITE <EndNote><Cite><Author>Passariello</Author><Year>2012</Year><RecNum>9053</RecNum><record><rec-number>9053</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Passariello, A.</author><author>Terrin, G.</author><author>Cecere, G.</author><author>Micillo, M.</author><author>De Marco, G.</author><author>Di Costanzo, M.</author><author>Cosenza, L.</author><author>Leone, L.</author><author>Nocerino, R.</author><author>Canani, R. B.</author></authors></contributors><auth-address>Department of Paediatrics, University of Naples &quot;Federico II&quot;, Italy.</auth-address><titles><title>Randomised clinical trial: efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060 plus arabinogalactan and xilooligosaccharides in children with acute diarrhoea</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>782-8</pages><volume>35</volume><number>7</number><keywords><keyword>Child, Preschool</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Diarrhea, Infantile/economics/ therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Galactans/ administration &amp; dosage</keyword><keyword>Glucuronates/ administration &amp; dosage</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Lactobacillus</keyword><keyword>Male</keyword><keyword>Oligosaccharides/ administration &amp; dosage</keyword><keyword>Parents/psychology</keyword><keyword>Prospective Studies</keyword><keyword>Severity of Illness Index</keyword><keyword>Synbiotics</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1365-2036 (Electronic)&#xD;0269-2813 (Linking)</isbn><accession-num>22324448</accession-num><urls></urls></record></Cite></EndNote>Passariello A, 2012L. paracasei B21060 plus arabinogalactan and xilooligosaccharides vs. placeboAdequateAdequateDBYesN=107 (3-36 mo)Higher rate of resolution of diarrhea at 72 hours (P=0.005).Reduced duration of diarrhea (P=0.04).Reduced number of daily stool outputs from 48 to 72 hours after treatment (P=0.005). ADDIN EN.CITE <EndNote><Cite><Author>Teran</Author><Year>2009</Year><RecNum>10396</RecNum><record><rec-number>10396</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Teran, C. G.</author><author>Teran-Escalera, C. N.</author><author>Villarroel, P.</author></authors></contributors><auth-address>Pediatric Center Albina Patino, Department of Infectious Disease, Calle Jordan 822, Cochabamba, Bolivia. carteran79@</auth-address><titles><title>Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>518-23</pages><volume>13</volume><number>4</number><keywords><keyword>Antiviral Agents/therapeutic use</keyword><keyword>Bolivia</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Drug Therapy, Combination</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Rotavirus Infections/ drug therapy</keyword><keyword>Single-Blind Method</keyword><keyword>Thiazoles/ therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>19070525</accession-num><urls></urls></record></Cite></EndNote>Teran CG, 2009Nitazoxanide Nitazoxanide 15 mg/kg/d for 3 days vs. placebo AdequateUnclearSBNo (ACA)N=75 (1-24 mo)Reduced duration of diarrhea (52.9±27.7 vs. 74.6±26.6 h; MD -21.7 h, 95% CI -34.74 to -8.66).Reduced duration of hospitalization (81.8±30.8 vs. 100.9±27.3; MD -19.1 h; 95% CI -33.27 to -4.93).AGE=acute gastroenteritis; ACA=available-case-analysis; CI=confidence interval; ED=Emergency department; HR=hazard ratio; IV=intravenous; LGG= Lactobacillus rhamnosus GG; MA=meta-analysis; MD=mean difference; OR=odds ratio; ORS=oral rehydration solution; ORT=oral rehydration treatment; RR=risk ratio; TID=?three times a day.5.4. Anti-infective therapyTable 5.4.1. Pathogen-based approach: Shigella gastroenteritisReferenceStudy type PopulationInterventionComparisonOutcome ADDIN EN.CITE <EndNote><Cite><Author>Vinh</Author><Year>2011</Year><RecNum>9258</RecNum><record><rec-number>9258</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vinh, H.</author><author>Anh, V. T.</author><author>Anh, N. D.</author><author>Campbell, J. I.</author><author>Hoang, N. V.</author><author>Nga, T. V.</author><author>Nhu, N. T.</author><author>Minh, P. V.</author><author>Thuy, C. T.</author><author>Duy, P. T.</author><author>Phuong le, T.</author><author>Loan, H. T.</author><author>Chinh, M. T.</author><author>Thao, N. T.</author><author>Tham, N. T.</author><author>Mong, B. L.</author><author>Bay, P. V.</author><author>Day, J. N.</author><author>Dolecek, C.</author><author>Lan, N. P.</author><author>Diep, T. S.</author><author>Farrar, J. J.</author><author>Chau, N. V.</author><author>Wolbers, M.</author><author>Baker, S.</author></authors></contributors><auth-address>The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.</auth-address><titles><title>A multi-center randomized trial to assess the efficacy of gatifloxacin versus ciprofloxacin for the treatment of shigellosis in Vietnamese children</title><secondary-title>PLoS Negl Trop Dis</secondary-title></titles><periodical><full-title>PLoS Negl Trop Dis</full-title></periodical><pages>e1264</pages><volume>5</volume><number>8</number><keywords><keyword>Anti-Bacterial Agents/adverse effects/ therapeutic use</keyword><keyword>Child, Preschool</keyword><keyword>Ciprofloxacin/ therapeutic use</keyword><keyword>Dysentery, Bacillary/blood/ drug therapy/metabolism</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Fluoroquinolones/adverse effects/ therapeutic use</keyword><keyword>Hospitals</keyword><keyword>Humans</keyword><keyword>Hyperglycemia/microbiology</keyword><keyword>Hypoglycemia/microbiology</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Proportional Hazards Models</keyword><keyword>Shigella/ isolation &amp; purification</keyword><keyword>Treatment Outcome</keyword><keyword>Vietnam</keyword></keywords><dates><year>2011</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1935-2735 (Electronic)&#xD;1935-2727 (Linking)</isbn><accession-num>21829747</accession-num><urls></urls></record></Cite></EndNote>Vinh H, 2011RCT, open-labelAllocation concealment494 hospitalized children with dysentery (107 with confirmed shigellosis)Gatifloxacin 10mg/kg/d (single dose), for 3 daysCiprofloxacin 30mg/kg/d (bid), for 3 daysSimilar duration of symptoms (95 vs 93 hs) and clinical failure rates ADDIN EN.CITE <EndNote><Cite><Author>Christopher</Author><Year>2010</Year><RecNum>12429</RecNum><record><rec-number>12429</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Christopher, P. R.</author><author>David, K. V.</author><author>John, S. M.</author><author>Sankarapandian, V.</author></authors></contributors><auth-address>Family Medicine, Christian Medical College, Vellore, Tamilnadu, India, 632004.</auth-address><titles><title>Antibiotic therapy for Shigella dysentery</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD006784</pages><number>8</number><keywords><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Diarrhea/drug therapy</keyword><keyword>Dysentery, Bacillary/ drug therapy</keyword><keyword>Furazolidone/therapeutic use</keyword><keyword>Humans</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Shigella</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination/therapeutic use</keyword></keywords><dates><year>2010</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>20687081</accession-num><urls></urls></record></Cite></EndNote>Christopher PR, 2010Meta-analysis1748 children and adults with Shigella dysentery 16 controlled trials of antibiotics for Shigella dysenteryPlacebo or comparative antibioticsAppropriate antimicrobial therapy shotened the duration of Shigella dysenteryInsufficient evidence to support superior efficacy of any class of antibiotics ADDIN EN.CITE <EndNote><Cite><Author>Boumghar-Bourtchai</Author><Year>2008</Year><RecNum>12477</RecNum><record><rec-number>12477</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Boumghar-Bourtchai, L.</author><author>Mariani-Kurkdjian, P.</author><author>Bingen, E.</author><author>Filliol, I.</author><author>Dhalluin, A.</author><author>Ifrane, S. A.</author><author>Weill, F. X.</author><author>Leclercq, R.</author></authors></contributors><auth-address>Centre Hospitalier Universitaire Cote de Nacre, Caen, France.</auth-address><titles><title>Macrolide-resistant Shigella sonnei</title><secondary-title>Emerg Infect Dis</secondary-title></titles><periodical><full-title>Emerg Infect Dis</full-title></periodical><pages>1297-9</pages><volume>14</volume><number>8</number><keywords><keyword>Anti-Bacterial Agents/ pharmacology</keyword><keyword>Child, Preschool</keyword><keyword>Disease Outbreaks</keyword><keyword>Drug Resistance, Multiple, Bacterial</keyword><keyword>Dysentery, Bacillary/microbiology</keyword><keyword>Electrophoresis, Gel, Pulsed-Field</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Macrolides/ pharmacology</keyword><keyword>Phylogeny</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Shigella sonnei/ drug effects</keyword></keywords><dates><year>2008</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1080-6059 (Electronic)&#xD;1080-6040 (Linking)</isbn><accession-num>18680661</accession-num><urls></urls></record></Cite></EndNote>Boumghar-Bourtchai L, 2008Case series 50 children, mostly hospitalized, with shigellosis, during an outbreak Identification of plasmid-mediated macrolide resistance-Macrolide-resistant S. Sonnei in France ADDIN EN.CITE <EndNote><Cite><Author>Centers for Disease Control and Prevention (CDC)</Author><Year>2012</Year><RecNum>12488</RecNum><record><rec-number>12488</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Centers for Disease Control and Prevention (CDC),</author></authors></contributors><titles><title>Notes from the field: Outbreak of infections caused by Shigella sonnei with decreased susceptibility to azithromycin--Los Angeles, California</title><secondary-title>MMWR Morb Mortal Wkly Rep</secondary-title></titles><periodical><full-title>MMWR Morb Mortal Wkly Rep</full-title></periodical><pages>171</pages><volume>62</volume><number>9</number><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Anti-Bacterial Agents/ pharmacology/therapeutic use</keyword><keyword>Azithromycin/ pharmacology/therapeutic use</keyword><keyword>Disease Outbreaks</keyword><keyword>Drug Resistance, Bacterial</keyword><keyword>Dysentery, Bacillary/ drug therapy/ epidemiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Los Angeles/epidemiology</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Middle Aged</keyword><keyword>Shigella sonnei/ isolation &amp; purification</keyword></keywords><dates><year>2012</year><pub-dates><date>Mar 8</date></pub-dates></dates><isbn>1545-861X (Electronic)&#xD;0149-2195 (Linking)</isbn><accession-num>23466436</accession-num><urls></urls></record></Cite></EndNote>Centers for Disease Control and Prevention (CDC), 2012Report of an outbreak43 cases of suspected shigellosis, 14 confirmed S. sonneiClinical and laboratory investigation -Plasmid-mediated azithronycin resistance (MIC>16 mcg/ml),Single clone by PFGE ADDIN EN.CITE <EndNote><Cite><Author>Centers for Disease Control and Prevention (CDC)</Author><Year>2010</Year><RecNum>9561</RecNum><record><rec-number>9561</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Centers for Disease Control and Prevention (CDC),</author></authors></contributors><titles><title>Notes from the field: emergence of Shigella flexneri 2a resistant to ceftriaxone and ciprofloxacin --- South Carolina</title><secondary-title>MMWR Morb Mortal Wkly Rep</secondary-title></titles><periodical><full-title>MMWR Morb Mortal Wkly Rep</full-title></periodical><pages>1619</pages><volume>59</volume><number>49</number><keywords><keyword>Adoption</keyword><keyword>Anti-Bacterial Agents/pharmacology/therapeutic use</keyword><keyword>Child, Preschool</keyword><keyword>China</keyword><keyword>Drug Resistance, Bacterial</keyword><keyword>Drug Resistance, Multiple</keyword><keyword>Dysentery, Bacillary/diagnosis/ drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Shigella flexneri/ drug effects/ isolation &amp; purification</keyword><keyword>South Carolina</keyword></keywords><dates><year>2010</year><pub-dates><date>Dec 17</date></pub-dates></dates><isbn>1545-861X (Electronic)&#xD;0149-2195 (Linking)</isbn><accession-num>21160457</accession-num><urls></urls></record></Cite></EndNote>Centers for Disease Control and Prevention (CDC), 2010Case series2 hospitalized children and an adult with clinical shigellosisDescriptive antibiotic resistance-Reprt from the US of S.flexneri 2a resistant to cefriaxone and ciprofloxacin ADDIN EN.CITE <EndNote><Cite><Author>Vrints</Author><Year>2009</Year><RecNum>12476</RecNum><record><rec-number>12476</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vrints, M.</author><author>Mairiaux, E.</author><author>Van Meervenne, E.</author><author>Collard, J. M.</author><author>Bertrand, S.</author></authors></contributors><auth-address>Section of Bacteriology, Scientific Institute of Public Health, Brussels, Belgium.</auth-address><titles><title>Surveillance of antibiotic susceptibility patterns among Shigella sonnei strains isolated in Belgium during the 18-year period 1990 to 2007</title><secondary-title>J Clin Microbiol</secondary-title></titles><periodical><full-title>J Clin Microbiol</full-title></periodical><pages>1379-85</pages><volume>47</volume><number>5</number><keywords><keyword>Anti-Bacterial Agents/ pharmacology</keyword><keyword>Belgium</keyword><keyword>Child, Preschool</keyword><keyword>DNA Transposable Elements</keyword><keyword>Drug Resistance, Bacterial</keyword><keyword>Dysentery, Bacillary/ microbiology</keyword><keyword>Gene Transfer, Horizontal</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>R Factors</keyword><keyword>Shigella sonnei/ drug effects/isolation &amp; purification</keyword></keywords><dates><year>2009</year><pub-dates><date>May</date></pub-dates></dates><isbn>1098-660X (Electronic)&#xD;0095-1137 (Linking)</isbn><accession-num>19321731</accession-num><urls></urls></record></Cite></EndNote>Vrints M, 2009Descriptive7307 Shigella isolates (children and adults) in Belgium During 1990-2007Descriptive antibiotic resistance-Very high resistance to ampicillin and TMP-SMXResistance to nalidixic acid (12.8%); no resistance to ciprofloxacin ADDIN EN.CITE <EndNote><Cite><Author>Shiferaw</Author><RecNum>8945</RecNum><record><rec-number>8945</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shiferaw, B.</author><author>Solghan, S.</author><author>Palmer, A.</author><author>Joyce, K.</author><author>Barzilay, E. J.</author><author>Krueger, A.</author><author>Cieslak, P.</author></authors></contributors><auth-address>Oregon Public Health Division, 800 NE Oregon St, Ste 772, Portland, OR 97232, USA. beletshachew.shiferaw@state.or.us</auth-address><titles><title>Antimicrobial susceptibility patterns of Shigella isolates in Foodborne Diseases Active Surveillance Network (FoodNet) sites, 2000-2010</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>S458-63</pages><volume>54 Suppl 5</volume><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Anti-Infective Agents/ pharmacology</keyword><keyword>Centers for Disease Control and Prevention (U.S.)</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Drug Resistance, Multiple, Bacterial</keyword><keyword>Dysentery, Bacillary/ethnology/ microbiology</keyword><keyword>European Continental Ancestry Group</keyword><keyword>Female</keyword><keyword>Foodborne Diseases/ethnology/ microbiology</keyword><keyword>Hispanic Americans</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Middle Aged</keyword><keyword>Shigella/ drug effects/ isolation &amp; purification</keyword><keyword>Travel</keyword><keyword>United States</keyword><keyword>Young Adult</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>22572670</accession-num><urls></urls></record></Cite></EndNote>Shiferaw B, 2012Descriptive1376 Shigella isolates (children and adults) in the US During 2000-2010Descriptive antibiotic resistance-High resistance to ampicillin and TMP-SMXLow resistance to nalidixic acid (2%) and ciprofloxacin (0.5%) ADDIN EN.CITE <EndNote><Cite><Author>Haltalin</Author><Year>1967</Year><RecNum>8413</RecNum><record><rec-number>8413</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haltalin, K. C.</author><author>Nelson, J. D.</author><author>Ring, R., 3rd</author><author>Sladoje, M.</author><author>Hinton, L. V.</author></authors></contributors><titles><title>Double-blind treatment study of shigellosis comparing ampicillin, sulfadiazine, and placebo</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>970-81</pages><volume>70</volume><number>6</number><keywords><keyword>Adolescent</keyword><keyword>Ampicillin/ therapeutic use</keyword><keyword>Aspartate Aminotransferases/blood</keyword><keyword>Candida/isolation &amp; purification</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Clinical Trials</keyword><keyword>Dysentery, Bacillary/ drug therapy/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Leukocyte Count</keyword><keyword>Male</keyword><keyword>Penicillin Resistance</keyword><keyword>Placebos</keyword><keyword>Shigella/isolation &amp; purification</keyword><keyword>Shigella dysenteriae/isolation &amp; purification</keyword><keyword>Shigella sonnei/isolation &amp; purification</keyword><keyword>Sodium/blood</keyword><keyword>Sulfadiazine/ therapeutic use</keyword></keywords><dates><year>1967</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>5338090</accession-num><urls></urls></record></Cite></EndNote>Haltalin KC, 1967Double-blindRCTAllocation concealment52 children hospitalizedWith Shigella GEAmpicllin vs sulfadiazine vs placeboLength of symptoms andFecal excretionAmpicillin (vs placebo) shortened the duratin of diarrhea by 45% (3.3 d vs 6), of fever by 50% (1.3 vs 2.6) and excretion by 60% (2 vs %) ADDIN EN.CITE <EndNote><Cite><Author>Basualdo</Author><Year>2003</Year><RecNum>1320</RecNum><record><rec-number>1320</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Basualdo, W.</author><author>Arbo, A.</author></authors></contributors><auth-address>Department of Pediatrics, Instituto de Medicina Tropical, Herrera 1459, Asuncion, Paraguay.</auth-address><titles><title>Randomized comparison of azithromycin versus cefixime for treatment of shigellosis in children</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>374-7</pages><volume>22</volume><number>4</number><keywords><keyword>Azithromycin/ administration &amp; dosage</keyword><keyword>Cefixime/ administration &amp; dosage</keyword><keyword>Chi-Square Distribution</keyword><keyword>Child, Preschool</keyword><keyword>Dose-Response Relationship, Drug</keyword><keyword>Drug Administration Schedule</keyword><keyword>Dysentery, Bacillary/diagnosis/ drug therapy</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Paraguay</keyword><keyword>Prospective Studies</keyword><keyword>Reference Values</keyword><keyword>Risk Assessment</keyword><keyword>Severity of Illness Index</keyword><keyword>Shigella/ drug effects/ isolation &amp; purification</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2003</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>12712971</accession-num><urls></urls></record></Cite></EndNote>Basualdo W, 2003Open-labelRCTAllocation concealment182 children with bloody diarrhea of whom 75 had shigellosis, mostly S. flexneriAzithromycin (12 and then 6 mg/d) vs cefixime (8mg/d), both for 5 dLength of symptoms andFecal excretion, clinical and bacteriologic relapse during 1w after end of therapyAzithro vs cefixime: clinical success 93% vs 78%, clinical failure 2 vs 7 children, legth of diarrhea 2.5 vs 3.9 d, bacterial eradication 93% vs 59% (p<0.01, 95% CO 1.7-69.7), clinical relapse 1 child in azithro group, bacteriologic relapse 1 vs 2 patients ADDIN EN.CITE <EndNote><Cite><Author>Ashkenazi</Author><Year>1993</Year><RecNum>4008</RecNum><record><rec-number>4008</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ashkenazi, S.</author><author>Amir, J.</author><author>Waisman, Y.</author><author>Rachmel, A.</author><author>Garty, B. Z.</author><author>Samra, Z.</author><author>Varsano, I.</author><author>Nitzan, M.</author></authors></contributors><auth-address>Department of Pediatrics, Children&apos;s Hospital, Petah Tiqva, Israel.</auth-address><titles><title>A randomized, double-blind study comparing cefixime and trimethoprim-sulfamethoxazole in the treatment of childhood shigellosis</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>817-21</pages><volume>123</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Cefixime</keyword><keyword>Cefotaxime/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea, Infantile/drug therapy/microbiology</keyword><keyword>Double-Blind Method</keyword><keyword>Dysentery, Bacillary/ drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Shigella/ drug effects</keyword><keyword>Shigella boydii/drug effects</keyword><keyword>Shigella flexneri/drug effects</keyword><keyword>Shigella sonnei/drug effects</keyword><keyword>Trimethoprim Resistance</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination/ therapeutic use</keyword></keywords><dates><year>1993</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>8229498</accession-num><urls></urls></record></Cite></EndNote>Ashkenazi S, 1993Double-blindRCTAllocation concealment102 children with inflammatory diarrhea, of whom 79 had shigellosis, mostly S. sonneiCefixime (8 mg/kg/d, bid vs T-S, 5dLength of symptoms andFecal excretionBetter clinical and bacteriological efficacy of cefixime, mainly because 32/39 treated with T-S were resistant to it. Bacteriologic eradication by cefixime was 78% (sub-optimal ) ADDIN EN.CITE <EndNote><Cite><Author>Miron</Author><Year>2004</Year><RecNum>891</RecNum><record><rec-number>891</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Miron, D.</author><author>Torem, M.</author><author>Merom, R.</author><author>Colodner, R.</author></authors></contributors><auth-address>Pediatric Department A, HaEmek Medical Center, Afula, Israel.</auth-address><titles><title>Azithromycin as an alternative to nalidixic acid in the therapy of childhood shigellosis</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>367-8</pages><volume>23</volume><number>4</number><keywords><keyword>Administration, Oral</keyword><keyword>Adolescent</keyword><keyword>Azithromycin/ administration &amp; dosage</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cohort Studies</keyword><keyword>Disease Outbreaks</keyword><keyword>Dose-Response Relationship, Drug</keyword><keyword>Drug Administration Schedule</keyword><keyword>Dysentery, Bacillary/diagnosis/ drug therapy/ epidemiology</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Israel/epidemiology</keyword><keyword>Male</keyword><keyword>Nalidixic Acid/ administration &amp; dosage</keyword><keyword>Probability</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Severity of Illness Index</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2004</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>15071299</accession-num><urls></urls></record></Cite></EndNote>Miron D, 2004Non-randomized controlled study during outbreak29 children with S. sonneiAzithromycin 10mg/kg for 3 d vs nalidixic acid 55mg/kg/d qid for 5 dLength of symptoms andFecal excretionBetter efficacy of azithromycin: clinical response 100% vs 65%, p<0.01, bacterilogic response 100% vs 72%, p=0/012 ADDIN EN.CITE <EndNote><Cite><Author>Varsano</Author><Year>1991</Year><RecNum>4845</RecNum><record><rec-number>4845</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Varsano, I.</author><author>Eidlitz-Marcus, T.</author><author>Nussinovitch, M.</author><author>Elian, I.</author></authors></contributors><auth-address>Department of Pediatrics and Microbiology, Tel Aviv University School of Medicine, Hasharon Hospital, Petah Tiqva, Israel.</auth-address><titles><title>Comparative efficacy of ceftriaxone and ampicillin for treatment of severe shigellosis in children</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>627-32</pages><volume>118</volume><number>4 ( Pt 1)</number><keywords><keyword>Adolescent</keyword><keyword>Ampicillin/ therapeutic use</keyword><keyword>Ceftriaxone/ therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dysentery, Bacillary/ drug therapy/microbiology</keyword><keyword>Feces/microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Prospective Studies</keyword><keyword>Shigella flexneri/isolation &amp; purification</keyword><keyword>Shigella sonnei/isolation &amp; purification</keyword></keywords><dates><year>1991</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>2007941</accession-num><urls></urls></record></Cite></EndNote>Varsano I, 1991OpenRCT49 children with severe dysentery, of whom 40 had shigellosis, mostly S. sonneiCeftriaxone 50mg/kg/d, IV then IM vs ampicillin 100mg/kg/d, IV then PO, both for 5dLength of symptoms andFecal excretion, relapse ratesBetter efficacy of ceftriaxone: diarrhea 2.5 vs 6.8 d (p<0.005), bacterial eradication 100% vs 60% (p<0.001), bacteriologic relapse 0 vs 40% (p<0.001) ADDIN EN.CITE <EndNote><Cite><Author>Eidlitz-Marcus</Author><Year>1993</Year><RecNum>8531</RecNum><record><rec-number>8531</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Eidlitz-Marcus, T.</author><author>Cohen, Y. H.</author><author>Nussinovitch, M.</author><author>Elian, I.</author><author>Varsano, I.</author></authors></contributors><auth-address>Department of Pediatrics, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.</auth-address><titles><title>Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>822-4</pages><volume>123</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Ceftriaxone/ administration &amp; dosage/therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea, Infantile/drug therapy/microbiology</keyword><keyword>Dose-Response Relationship, Drug</keyword><keyword>Dysentery, Bacillary/ drug therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Shigella flexneri</keyword><keyword>Shigella sonnei</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>1993</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>8229499</accession-num><urls></urls></record></Cite></EndNote>Eidlitz-Marcus T, 1993OpenRCT40 children with shigellosis, mostly S. sonneiCeftriaxone 50mg/kg/d, IV then IM 5d vs 2dLength of symptoms andFecal excretionNo difference between 2 and 5 days ADDIN EN.CITE <EndNote><Cite><Author>Salam</Author><Year>1988</Year><RecNum>5743</RecNum><record><rec-number>5743</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Salam, M. A.</author><author>Bennish, M. L.</author></authors></contributors><auth-address>Dhaka Treatment Centre, International Centre for Diarrhoeal Disease Research, Bangladesh.</auth-address><titles><title>Therapy for shigellosis. I. Randomized, double-blind trial of nalidixic acid in childhood shigellosis</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>901-7</pages><volume>113</volume><number>5</number><keywords><keyword>Ampicillin/therapeutic use</keyword><keyword>Ampicillin Resistance</keyword><keyword>Child, Preschool</keyword><keyword>Clinical Trials</keyword><keyword>Double-Blind Method</keyword><keyword>Dysentery, Bacillary/ drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Nalidixic Acid/ therapeutic use</keyword><keyword>Random Allocation</keyword></keywords><dates><year>1988</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>3054035</accession-num><urls></urls></record></Cite></EndNote>Salam MA, 1988Double-blindRCT9o children with dysentery, of whom 74 had shigellosis, mostly S. dysenteriae and S. sonneiNalidixic acid 55 mg/kg/d vs ampicillin 100 mg/kg/d, both for 5dLength of symptoms andFecal excretionNalidixic acid and Ampicillin effective, when the isolate susceptible to Ampicillin. Clinical response 81% vs 77%, Bacteriologic response 100% for both groups on d 3, but the response after 1d was better (38% vs 12%) ADDIN EN.CITE <EndNote><Cite><Author>Bennish</Author><Year>2006</Year><RecNum>50</RecNum><record><rec-number>50</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bennish, M. L.</author><author>Khan, W. A.</author><author>Begum, M.</author><author>Bridges, E. A.</author><author>Ahmed, S.</author><author>Saha, D.</author><author>Salam, M. A.</author><author>Acheson, D.</author><author>Ryan, E. T.</author></authors></contributors><auth-address>Africa Centre for Health and Population Studies, Mtubatuba, South Africa.</auth-address><titles><title>Low risk of hemolytic uremic syndrome after early effective antimicrobial therapy for Shigella dysenteriae type 1 infection in Bangladesh</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>356-62</pages><volume>42</volume><number>3</number><keywords><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Bangladesh</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dysentery, Bacillary/ complications/drug therapy/ microbiology</keyword><keyword>Feces/chemistry</keyword><keyword>Female</keyword><keyword>Hemolytic-Uremic Syndrome/ etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Shiga Toxin/analysis</keyword><keyword>Shigella dysenteriae/ isolation &amp; purification</keyword></keywords><dates><year>2006</year><pub-dates><date>Feb 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)</isbn><accession-num>16392080</accession-num><urls></urls></record></Cite></EndNote>Bennish ML, 2006Review of 7 studies and follow up of 20 children prospectively378 patients with S. dysenteriae, 250 children, 128 adultsAppropriate antibiotic therapyRate of the HUS complication, fecal Stx levelLow risk of developing HUS with therapy( 0.0026), early antibiotics reduces fecal Stx levels ADDIN EN.CITE <EndNote><Cite><Author>Leibovitz</Author><Year>2000</Year><RecNum>2028</RecNum><record><rec-number>2028</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leibovitz, E.</author><author>Janco, J.</author><author>Piglansky, L.</author><author>Press, J.</author><author>Yagupsky, P.</author><author>Reinhart, H.</author><author>Yaniv, I.</author><author>Dagan, R.</author></authors></contributors><auth-address>Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. eugenel@bgumail.ac.il</auth-address><titles><title>Oral ciprofloxacin vs. intramuscular ceftriaxone as empiric treatment of acute invasive diarrhea in children</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>1060-7</pages><volume>19</volume><number>11</number><keywords><keyword>Acute Disease</keyword><keyword>Administration, Oral</keyword><keyword>Adolescent</keyword><keyword>Anti-Infective Agents/ therapeutic use</keyword><keyword>Ceftriaxone/administration &amp; dosage/adverse effects/ therapeutic use</keyword><keyword>Cephalosporins/ therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Ciprofloxacin/adverse effects/blood/ therapeutic use</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Injections, Intramuscular</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2000</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>11099086</accession-num><urls></urls></record></Cite></EndNote>Leibovitz E, 2000Double-blind RCT221 children with invasive diarrhea, 73 with shigellosisCiprofloxacin PO 20mg/kg/d bid vs IM ceftriaxone 50/mg/kg, both 3dLength of symptoms andFecal excretionNo differences in the clinical or bacteriologic response. No joint problems related to cipro treatmet for 3 d ADDIN EN.CITE <EndNote><Cite><Author>Prado</Author><Year>1992</Year><RecNum>4434</RecNum><record><rec-number>4434</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prado, D.</author><author>Lopez, E.</author><author>Liu, H.</author><author>Devoto, S.</author><author>Woloj, M.</author><author>Contrini, M.</author><author>Murray, B. E.</author><author>Gomez, H.</author><author>Cleary, T. G.</author></authors></contributors><auth-address>Hospital General San Juan de Dios, Guatemala.</auth-address><titles><title>Ceftibuten and trimethoprim-sulfamethoxazole for treatment of Shigella and enteroinvasive Escherichia coli disease</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>644-7</pages><volume>11</volume><number>8</number><keywords><keyword>Adolescent</keyword><keyword>Cephalosporins/ therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Dysentery, Bacillary/ drug therapy</keyword><keyword>Escherichia coli Infections/ drug therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Prospective Studies</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination/ therapeutic use</keyword></keywords><dates><year>1992</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>1523076</accession-num><urls></urls></record></Cite></EndNote>Prado D, 1992RCT93 children with dysentery, of whom 22 had shigellosis or EIECCeftibuten 9 mg/kg/d vs T-S 10-50mg/kg/dBoth bid, for 5dLength of symptoms andFecal excretionSimilar clinical and bacteriologic responses unless the pathogen was resistant to T-S ADDIN EN.CITE <EndNote><Cite><Author>DuPont</Author><Year>2001</Year><RecNum>8532</RecNum><record><rec-number>8532</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>DuPont, H. L.</author><author>Jiang, Z. D.</author><author>Ericsson, C. D.</author><author>Adachi, J. A.</author><author>Mathewson, J. J.</author><author>DuPont, M. W.</author><author>Palazzini, E.</author><author>Riopel, L. M.</author><author>Ashley, D.</author><author>Martinez-Sandoval, F.</author></authors></contributors><auth-address>Center for Infectious Diseases, The University of Texas-Houston School of Public Health and Medical School, 77030, USA. hdupont@</auth-address><titles><title>Rifaximin versus ciprofloxacin for the treatment of traveler&apos;s diarrhea: a randomized, double-blind clinical trial</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>1807-15</pages><volume>33</volume><number>11</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Anti-Infective Agents/adverse effects/ therapeutic use</keyword><keyword>Ciprofloxacin/adverse effects/ therapeutic use</keyword><keyword>Diarrhea/diagnosis/ drug therapy/microbiology</keyword><keyword>Double-Blind Method</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Kinetics</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Middle Aged</keyword><keyword>Rifamycins/adverse effects/ therapeutic use</keyword></keywords><dates><year>2001</year><pub-dates><date>Dec 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)</isbn><accession-num>11692292</accession-num><urls></urls></record></Cite></EndNote>DuPont HL, 2001Double-blindRCT187 adults with traveler’s diarrhea, 9 with Shigella, no studt in childrenRifaximin 400 mgX2/d vs Ciprofloxacin 500 mgX2/d, both for 3 dLength of symptoms andFecal excretionSimilar clinical and bacterial efficay. But: only 9 Shigella, 64 ETEC; no studies in childrenAGE=acute gastroenteritis; ED=Emergency department; EIEC=enteroinvasive E. coli; ETEC=enterotoxigenic E. coli; HUS=hemolytic-uremic syndrome; IM=intramuscular; IV=Intravenous; LGG=Lactobacillus rhamnosus GG; ORS=Oral rehydration solution; ORT=Oral rehydration treatment; PO=Oral; Stx=Shiga toxin; TID=?three times a day; T-S=trimethoprim-sulfamethoxazole.Table 5.4.2. Pathogen-based approach: Salmonella (non-typhoidal) gastroenteritisReferenceStudy type PopulationInterventionComparisonOutcome ADDIN EN.CITE <EndNote><Cite><Author>Onwuezobe</Author><Year>2012</Year><RecNum>8773</RecNum><record><rec-number>8773</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Onwuezobe, I. A.</author><author>Oshun, P. O.</author><author>Odigwe, C. C.</author></authors></contributors><auth-address>Medical Microbiology and Parasitology, University of Uyo Teaching Hospital, Uyo, Nigeria. ifezobe@.</auth-address><titles><title>Antimicrobials for treating symptomatic non-typhoidal Salmonella infection</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD001167</pages><volume>11</volume><keywords><keyword>Adult</keyword><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy/microbiology</keyword><keyword>Gastroenteritis/drug therapy</keyword><keyword>Gastrointestinal Diseases/drug therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Salmonella Infections/ drug therapy</keyword><keyword>Salmonella paratyphi A</keyword><keyword>Salmonella typhi</keyword></keywords><dates><year>2012</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>23152205</accession-num><urls></urls></record></Cite></EndNote>Onwuezobe IA, 2012Systematic Reviewof RCTs1980-8/201212 trials identifiedIncluding 767 patients with Salmonella gastroenteritis, of whom 258 were childrenAntibiotics vs placebo or no antibioticsClinical and bacteriologic responses, relapse, adverse effectsNo significant differences in length of diarrhea or fever between any antibiotic regimen and placebo. Antibiotics result in more negative cultures during the 1st week of treatment, but more cases of positive cultures after 3 weeks. Relapse more frequent in those receiving antibiotics. Adverse effects more common with antibiotics ADDIN EN.CITE <EndNote><Cite><Author>Shkalim</Author><Year>2012</Year><RecNum>9118</RecNum><record><rec-number>9118</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shkalim, V.</author><author>Amir, A.</author><author>Samra, Z.</author><author>Amir, J.</author></authors></contributors><auth-address>Pediatric Hematology-Oncology, Schneider Children&apos;s Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49202, Israel. shine6@walla.co.il</auth-address><titles><title>Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children</title><secondary-title>Infection</secondary-title></titles><periodical><full-title>Infection</full-title></periodical><pages>285-9</pages><volume>40</volume><number>3</number><keywords><keyword>Bacteremia/blood/epidemiology/ microbiology</keyword><keyword>Case-Control Studies</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/complications/epidemiology/microbiology</keyword><keyword>Dysentery/complications/epidemiology/microbiology</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Fever/complications/epidemiology/microbiology</keyword><keyword>Gastroenteritis/blood/ complications/epidemiology/ microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Israel</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Retrospective Studies</keyword><keyword>Salmonella/ isolation &amp; purification</keyword><keyword>Salmonella Infections/blood/ complications/epidemiology/ microbiology</keyword><keyword>Seasons</keyword><keyword>Seizures/complications/epidemiology/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1439-0973 (Electronic)&#xD;0300-8126 (Linking)</isbn><accession-num>22161258</accession-num><urls></urls></record></Cite></EndNote>Shkalim V, 2012Descriptive study17 children with non-typoidal Salmonella bacteremia during 1995-2010--Salmonella bacteremia was associated with toxic appearance and convulsions (17%) and occurred in children older than 3 months ADDIN EN.CITE <EndNote><Cite><Author>Chiu</Author><Year>1999</Year><RecNum>2428</RecNum><record><rec-number>2428</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chiu, C. H.</author><author>Lin, T. Y.</author><author>Ou, J. T.</author></authors></contributors><auth-address>Division of Paediatric Infectious Diseases, Department of Medicine, Chang Gung Children&apos;s Hospital, Taoyuan, Taiwan.</auth-address><titles><title>A clinical trial comparing oral azithromycin, cefixime and no antibiotics in the treatment of acute uncomplicated Salmonella enteritis in children</title><secondary-title>J Paediatr Child Health</secondary-title></titles><periodical><full-title>J Paediatr Child Health</full-title></periodical><pages>372-4</pages><volume>35</volume><number>4</number><keywords><keyword>Administration, Oral</keyword><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Azithromycin/ therapeutic use</keyword><keyword>Cefixime</keyword><keyword>Cefotaxime/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Cephalosporins/ therapeutic use</keyword><keyword>Enteritis/ drug therapy/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Salmonella Infections/ drug therapy/microbiology</keyword></keywords><dates><year>1999</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1034-4810 (Print)</isbn><accession-num>10457295</accession-num><urls></urls></record></Cite></EndNote>Chiu CH, 1999Open-label RCTAllocation concealment42 children with Salmonella GEAzithromycin 10mg/kg/d vs cefixime 10mg/kg/d bid, both for 5 days vs no antibioticsClinical and bacteriologic responsesDuration of diarrhea or fever not affected by antibiotics. No effects of antibiotics on fecal eradication ADDIN EN.CITE <EndNote><Cite><Author>Sirinavin</Author><Year>2003</Year><RecNum>8533</RecNum><record><rec-number>8533</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirinavin, S.</author><author>Thavornnunth, J.</author><author>Sakchainanont, B.</author><author>Bangtrakulnonth, A.</author><author>Chongthawonsatid, S.</author><author>Junumporn, S.</author></authors></contributors><auth-address>Clinical Epidemiology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rassr@mahidol.ac.th</auth-address><titles><title>Norfloxacin and azithromycin for treatment of nontyphoidal salmonella carriers</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>685-91</pages><volume>37</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Anti-Infective Agents/therapeutic use</keyword><keyword>Azithromycin/ therapeutic use</keyword><keyword>Bacterial Typing Techniques</keyword><keyword>Carrier State/ drug therapy/ microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Norfloxacin/ therapeutic use</keyword><keyword>Salmonella/classification/ drug effects/isolation &amp; purification</keyword><keyword>Salmonella Infections/ diagnosis/ drug therapy</keyword><keyword>Salmonella enterica/classification/isolation &amp; purification</keyword><keyword>Salmonella typhimurium/classification/isolation &amp; purification</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2003</year><pub-dates><date>Sep 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)</isbn><accession-num>12942401</accession-num><urls></urls></record></Cite></EndNote>Sirinavin S, 2003Open-label RCT265 asymptomatic carriers of SalmonellaNorfloxacin 400 mgx2/d vs Azithromycin 500 mg/d, both for 5 days, vs placeboFecal eradication: stool cultures on days 7, 30, 60, 90.Antibiotic regimens had no significant effect vs placebo on fecal eradication, and was associated with development of antibiotic resistanceTable 5.4.3. Pathogen-based approach: Campylobacter gastroenteritisReferenceStudy type PopulationInterventionComparisonOutcome ADDIN EN.CITE <EndNote><Cite><Author>Vukelic</Author><Year>2010</Year><RecNum>10044</RecNum><record><rec-number>10044</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vukelic, D.</author><author>Trkulja, V.</author><author>Salkovic-Petrisic, M.</author></authors></contributors><auth-address>University Hospital for Infectious Disease Dr. Fran Mihaljevic, Mirogojska, Croatia. dvukelic@bfm.hr</auth-address><titles><title>Single oral dose of azithromycin versus 5 days of oral erythromycin or no antibiotic in treatment of campylobacter enterocolitis in children: a prospective randomized assessor-blind study</title><secondary-title>J Pediatr Gastroenterol Nutr</secondary-title></titles><periodical><full-title>J Pediatr Gastroenterol Nutr</full-title></periodical><pages>404-10</pages><volume>50</volume><number>4</number><keywords><keyword>Administration, Oral</keyword><keyword>Azithromycin/ administration &amp; dosage/pharmacology</keyword><keyword>Campylobacter/ drug effects</keyword><keyword>Child, Preschool</keyword><keyword>Drug Administration Schedule</keyword><keyword>Drug Therapy, Combination</keyword><keyword>Enterocolitis/ drug therapy/microbiology</keyword><keyword>Erythromycin/ administration &amp; dosage/pharmacology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Intention to Treat Analysis</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Single-Blind Method</keyword></keywords><dates><year>2010</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1536-4801 (Electronic)&#xD;0277-2116 (Linking)</isbn><accession-num>19881393</accession-num><urls></urls></record></Cite></EndNote>Vukelic D, 2010RCTAssessor-blindAllocation concealment120 children (<12 y) with Campylobacter enterocolitisSingle dose (20 or 30 mg/kg) azithromycinErythromycin for 5 daysNo antibioticsErythromycin was not better than no antibioticsA single dose of azithromycin, 30 mg/kg, was superior to no antibiotics and to erythromycinAll antibiotic regimens had 100% bacteriologic cure ADDIN EN.CITE <EndNote><Cite><Author>Ternhag</Author><Year>2007</Year><RecNum>8542</RecNum><record><rec-number>8542</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ternhag, A.</author><author>Asikainen, T.</author><author>Giesecke, J.</author><author>Ekdahl, K.</author></authors></contributors><auth-address>Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden. anders.ternhag@karolinska.se</auth-address><titles><title>A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>696-700</pages><volume>44</volume><number>5</number><dates><year>2007</year><pub-dates><date>Mar 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)</isbn><accession-num>17278062</accession-num><urls></urls></record></Cite></EndNote>Ternhag A, 2007Meta-analysis11 double-blind RCTsAntibiotics vs no treatment or placeboClinical and bacteriologic outcomeAntibiotics reduced the duration of intestinal symptoms by a mean of 1.3 days ADDIN EN.CITE <EndNote><Cite><Author>Salazar-Lindo</Author><Year>1986</Year><RecNum>6229</RecNum><record><rec-number>6229</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Salazar-Lindo, E.</author><author>Sack, R. B.</author><author>Chea-Woo, E.</author><author>Kay, B. A.</author><author>Piscoya, Z. A.</author><author>Leon-Barua, R.</author><author>Yi, A.</author></authors></contributors><titles><title>Early treatment with erythromycin of Campylobacter jejuni-associated dysentery in children</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>355-60</pages><volume>109</volume><number>2</number><keywords><keyword>Campylobacter Infections/ drug therapy</keyword><keyword>Campylobacter fetus/isolation &amp; purification</keyword><keyword>Child, Preschool</keyword><keyword>Double-Blind Method</keyword><keyword>Dysentery/ drug therapy/etiology</keyword><keyword>Erythromycin/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Erythromycin Ethylsuccinate</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Placebos</keyword><keyword>Random Allocation</keyword><keyword>Time Factors</keyword><keyword>Americas</keyword><keyword>Antibiotics</keyword><keyword>Biology</keyword><keyword>Demographic Factors</keyword><keyword>Developed Countries</keyword><keyword>Developing Countries</keyword><keyword>Diarrhea</keyword><keyword>Diarrhea, Infantile</keyword><keyword>Diseases</keyword><keyword>Drugs</keyword><keyword>Evaluation</keyword><keyword>Examinations And Diagnoses</keyword><keyword>Gastrointestinal Effects</keyword><keyword>Laboratory Examinations And Diagnoses</keyword><keyword>Latin America</keyword><keyword>Peru</keyword><keyword>Physiology</keyword><keyword>Population</keyword><keyword>Population Characteristics</keyword><keyword>South America</keyword><keyword>Treatment</keyword></keywords><dates><year>1986</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>3488385</accession-num><urls></urls></record></Cite></EndNote>Salazar-Lindo E, 1986Double-blind RCTAllocation concealment170 children 3-60 mo with acute dysentery, of whom 30 had Campylobacter jejuniTreatment started within 5 days of diarrheaErythromycin 50mg/kg/d qid for 5 days vs placebo Clinical and bacteriologic responses Treatment failure clinically 0% vs 42% (p<0.01), diarrhea after 2d 0% vs 64% (p<0.05), normal stools after 5 d 7% vs 50% (p<0.02), shorter excretion of the pathogen. Clinical and bacteriologic efficacy documented with the early treatment, for dysenteric Campy GE and with a dose of 50mg/kg/d ADDIN EN.CITE <EndNote><Cite><Author>Williams</Author><Year>1989</Year><RecNum>5606</RecNum><record><rec-number>5606</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Williams, M. D.</author><author>Schorling, J. B.</author><author>Barrett, L. J.</author><author>Dudley, S. M.</author><author>Orgel, I.</author><author>Koch, W. C.</author><author>Shields, D. S.</author><author>Thorson, S. M.</author><author>Lohr, J. A.</author><author>Guerrant, R. L.</author></authors></contributors><auth-address>Department of Medicine, University of Virginia Medical Center, Charlottesville 22908.</auth-address><titles><title>Early treatment of Campylobacter jejuni enteritis</title><secondary-title>Antimicrob Agents Chemother</secondary-title></titles><periodical><full-title>Antimicrob Agents Chemother</full-title></periodical><pages>248-50</pages><volume>33</volume><number>2</number><keywords><keyword>Adult</keyword><keyword>Campylobacter Infections/ drug therapy/microbiology</keyword><keyword>Campylobacter fetus/drug effects</keyword><keyword>Child</keyword><keyword>Drug Combinations/pharmacology/therapeutic use</keyword><keyword>Enteritis/ drug therapy/microbiology</keyword><keyword>Erythromycin/pharmacology/ therapeutic use</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microbial Sensitivity Tests</keyword><keyword>Sulfamethoxazole/pharmacology/ therapeutic use</keyword><keyword>Time Factors</keyword><keyword>Trimethoprim/pharmacology/ therapeutic use</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination</keyword></keywords><dates><year>1989</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0066-4804 (Print)</isbn><accession-num>2818711</accession-num><urls></urls></record></Cite></EndNote>Williams MD, 1989Open-label RCTAllocation concealment20 children (>6m) and 23 adults with acute (<72h) inflammatory diarrhea were enrolled. 21 were C. Jejuni positiveErythromycin 50mg/kg/d tid vs TMP-SMX, both for 5 days Clinical and bacteriologic responsesIn those with Campy GE: eryhromycin was bacterilogical efficacious – fecal eradication on d3 was 100% vs 10% (p<0.002) and on d5 100% vs 20% (p<0.001). Clinically, no significant effect on mean days of diarrhea, mean stools per day and mean symptom score ADDIN EN.CITE <EndNote><Cite><Author>Pai</Author><Year>1983</Year><RecNum>6982</RecNum><record><rec-number>6982</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pai, C. H.</author><author>Gillis, F.</author><author>Tuomanen, E.</author><author>Marks, M. I.</author></authors></contributors><titles><title>Erythromycin in treatment of Campylobacter enteritis in children</title><secondary-title>Am J Dis Child</secondary-title></titles><periodical><full-title>Am J Dis Child</full-title></periodical><pages>286-8</pages><volume>137</volume><number>3</number><keywords><keyword>Campylobacter Infections/ drug therapy</keyword><keyword>Campylobacter fetus/isolation &amp; purification</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/drug therapy</keyword><keyword>Enteritis/ drug therapy/microbiology</keyword><keyword>Erythromycin/ analogs &amp; derivatives/therapeutic use</keyword><keyword>Erythromycin Ethylsuccinate</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword></keywords><dates><year>1983</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0002-922X (Print)</isbn><accession-num>6600579</accession-num><urls></urls></record></Cite></EndNote>Pai CH, 1983Open-label RCT27 children with confirmed Campy GEErythromycin 40mg/kg/d qid for 7 days vs no treatmentNean diarrhea before treatment: 5.5 vs 6.4d!!!Clinical and bacteriologic responsesrelapseDuration of diarrhea (3.2 vs 3.8) or fever Bacterial shedding: 2 vs 16.8 d (p<0.05)Relapse: 6.7% vs 25% ADDIN EN.CITE <EndNote><Cite><Author>Ashkenazi</Author><Year>1987</Year><RecNum>8534</RecNum><record><rec-number>8534</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ashkenazi, S.</author><author>Danziger, Y.</author><author>Varsano, Y.</author><author>Peilan, J.</author><author>Mimouni, M.</author></authors></contributors><titles><title>Treatment of Campylobacter gastroenteritis</title><secondary-title>Arch Dis Child</secondary-title></titles><periodical><full-title>Arch Dis Child</full-title></periodical><pages>84-5</pages><volume>62</volume><number>1</number><keywords><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Campylobacter Infections/complications/ drug therapy</keyword><keyword>Campylobacter fetus/isolation &amp; purification</keyword><keyword>Diarrhea/etiology</keyword><keyword>Diseases in Twins</keyword><keyword>Feces/microbiology</keyword><keyword>Gastroenteritis/ drug therapy</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Recurrence</keyword></keywords><dates><year>1987</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1468-2044 (Electronic)</isbn><accession-num>3813645</accession-num><urls></urls></record></Cite></EndNote>Ashkenazi S, 1987Intervention during a DCC outbreakOngoing outbreak of Campy GE in a DCC, 22 childrenErythromycin 50mg/kg/d qidFor 7 daysFecal eradication, outbreak course.The ongoing outbreak stoppedDCC=day-care center; D=day; GE=gastroenteritis.Table 5.4.4. Pathogen-based approach: E. coli, cholera, others gastroenteritisReferenceStudy type PopulationInterventionComparisonOutcome ADDIN EN.CITE <EndNote><Cite><Author>Kaushik</Author><Year>2010</Year><RecNum>12434</RecNum><record><rec-number>12434</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaushik, J. S.</author><author>Gupta, P.</author><author>Faridi, M. M.</author><author>Das, S.</author></authors></contributors><auth-address>Department of Pediatrics University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India. jayashankarkaushik@</auth-address><titles><title>Single dose azithromycin versus ciprofloxacin for cholera in children: a randomized controlled trial</title><secondary-title>Indian Pediatr</secondary-title></titles><periodical><full-title>Indian Pediatr</full-title></periodical><pages>309-15</pages><volume>47</volume><number>4</number><keywords><keyword>Azithromycin/ administration &amp; dosage</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cholera/ drug therapy/microbiology</keyword><keyword>Ciprofloxacin/ administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>Treatment Failure</keyword><keyword>Vibrio cholerae</keyword></keywords><dates><year>2010</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0974-7559 (Electronic)&#xD;0019-6061 (Linking)</isbn><accession-num>19578229</accession-num><urls></urls></record></Cite></EndNote>Kaushik JS, 2010RCTAllocation concealment180 hospitalized children with confirmed cholera diarrheaAzithromycin, single 20/mg/kg doseCiprofloxacin, single 20mg/kg doseAzithromycin superior: clinical efficacy 95% vs 71%, bacteriologic efficacy 100% vs 96%, duration of diarrhea 55 vs 72 h and vibrio excretion 35 vs 52 h and less IV fluid needed (3491 vs 4705 ml. ADDIN EN.CITE <EndNote><Cite><Author>Wong</Author><Year>2012</Year><RecNum>12430</RecNum><record><rec-number>12430</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wong, C. S.</author><author>Mooney, J. C.</author><author>Brandt, J. R.</author><author>Staples, A. O.</author><author>Jelacic, S.</author><author>Boster, D. R.</author><author>Watkins, S. L.</author><author>Tarr, P. I.</author></authors></contributors><auth-address>Department of Pediatrics, Division of Nephrology, University of New Mexico Children&apos;s Hospital, Albuquerque, USA.</auth-address><titles><title>Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>33-41</pages><volume>55</volume><number>1</number><keywords><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Escherichia coli Infections/ complications/drug therapy/epidemiology</keyword><keyword>Escherichia coli O157/ isolation &amp; purification</keyword><keyword>Female</keyword><keyword>Hemolytic-Uremic Syndrome/epidemiology/ microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Leukocyte Count</keyword><keyword>Logistic Models</keyword><keyword>Male</keyword><keyword>Multivariate Analysis</keyword><keyword>Oliguria/epidemiology</keyword><keyword>Retrospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Vomiting/microbiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1537-6591 (Electronic)&#xD;1058-4838 (Linking)</isbn><accession-num>22431799</accession-num><urls></urls></record></Cite></EndNote>Wong CS, 2012Case-control study259 children with O157:H7 diarrheaAntibioticsNo antibioticsHUS rate: 36% with antibiotics vs 12% without (p=0.001) ADDIN EN.CITE <EndNote><Cite><Author>Geerdes-Fenge</Author><Year>2013</Year><RecNum>12431</RecNum><record><rec-number>12431</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Geerdes-Fenge, H. F.</author><author>Lobermann, M.</author><author>Nurnberg, M.</author><author>Fritzsche, C.</author><author>Koball, S.</author><author>Henschel, J.</author><author>Hohn, R.</author><author>Schober, H. C.</author><author>Mitzner, S.</author><author>Podbielski, A.</author><author>Reisinger, E. C.</author></authors></contributors><auth-address>Department of Medicine, Division of Tropical Medicine and Infectious Diseases, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany, hilte.geerdes-fenge@med.uni-rostock.de.</auth-address><titles><title>Ciprofloxacin reduces the risk of hemolytic uremic syndrome in patients with Escherichia coli O104:H4-associated diarrhea</title><secondary-title>Infection</secondary-title></titles><periodical><full-title>Infection</full-title></periodical><pages>669-73</pages><volume>41</volume><number>3</number><dates><year>2013</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1439-0973 (Electronic)&#xD;0300-8126 (Linking)</isbn><accession-num>23292662</accession-num><urls></urls></record></Cite></EndNote>Geerdes-Fenge HF, 2013Case-control study24 patients with EHEC (O104:H4) diarrheaCiprofloxacinOther or no antibioticsHUS rate: 40% with ciprofloxacin vs 89% without ciprofloxacin (p=0.043) ADDIN EN.CITE <EndNote><Cite><Author>Trehan</Author><Year>2009</Year><RecNum>12433</RecNum><record><rec-number>12433</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trehan, I.</author><author>Shulman, R. J.</author><author>Ou, C. N.</author><author>Maleta, K.</author><author>Manary, M. J.</author></authors></contributors><auth-address>Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA.</auth-address><titles><title>A randomized, double-blind, placebo-controlled trial of rifaximin, a nonabsorbable antibiotic, in the treatment of tropical enteropathy</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>2326-33</pages><volume>104</volume><number>9</number><keywords><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Child, Preschool</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lactulose/urine</keyword><keyword>Malabsorption Syndromes/ drug therapy/microbiology</keyword><keyword>Malawi</keyword><keyword>Male</keyword><keyword>Mannitol/urine</keyword><keyword>Rifamycins/ therapeutic use</keyword><keyword>Sucrose/analogs &amp; derivatives/urine</keyword><keyword>Tropical Climate</keyword></keywords><dates><year>2009</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1572-0241 (Electronic)&#xD;0002-9270 (Linking)</isbn><accession-num>19491826</accession-num><urls></urls></record></Cite></EndNote>Trehan I, 2009RCTDouble-blindAllocation concealment144 ambulatory children aged 3-5 years with tropical enteropathyPO rifaximin for 7 daysPlaceboNo beneficial effect of rifaximin, "suggesting that small-bowel bacterial over growth in not an important etiology in this condition ADDIN EN.CITE <EndNote><Cite><Author>Hu</Author><Year>2012</Year><RecNum>12432</RecNum><record><rec-number>12432</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hu, Y.</author><author>Ren, J.</author><author>Zhan, M.</author><author>Li, W.</author><author>Dai, H.</author></authors></contributors><auth-address>Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.</auth-address><titles><title>Efficacy of rifaximin in prevention of travelers&apos; diarrhea: a meta-analysis of randomized, double-blind, placebo-controlled trials</title><secondary-title>J Travel Med</secondary-title></titles><periodical><full-title>J Travel Med</full-title></periodical><pages>352-6</pages><volume>19</volume><number>6</number><dates><year>2012</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1708-8305 (Electronic)&#xD;1195-1982 (Linking)</isbn><accession-num>23379704</accession-num><urls></urls></record></Cite></EndNote>Hu Y, 2012Meta-analysis4 RCTs including 502 participantsPO rifaximinPlaceboRifaximin reduced significantly the rate of non-invasive E. coli (mainly ETEC) diarrhea ADDIN EN.CITE <EndNote><Cite><Author>Safdar</Author><Year>2002</Year><RecNum>8535</RecNum><record><rec-number>8535</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Safdar, N.</author><author>Said, A.</author><author>Gangnon, R. E.</author><author>Maki, D. G.</author></authors></contributors><auth-address>Department of Medicine, University of Wisconsin Medical School and University of Wisconsin Hospital and Clinics, Madison, WI 53792-5158, USA.</auth-address><titles><title>Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis</title><secondary-title>Jama</secondary-title></titles><periodical><full-title>Jama</full-title></periodical><pages>996-1001</pages><volume>288</volume><number>8</number><keywords><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Enteritis/complications/drug therapy/ microbiology</keyword><keyword>Escherichia coli Infections/ complications/ drug therapy</keyword><keyword>Escherichia coli O157</keyword><keyword>Hemolytic-Uremic Syndrome/ epidemiology/etiology/microbiology</keyword><keyword>Humans</keyword><keyword>Risk Factors</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2002</year><pub-dates><date>Aug 28</date></pub-dates></dates><isbn>0098-7484 (Print)</isbn><accession-num>12190370</accession-num><urls></urls></record></Cite></EndNote>Safdar N, 2002Meta-analysisO157:H7 and HUS 26 publications were identified; 9 fulfilled the criteria for inclusion in the analysisOnly one randomized, the others prospective cohort or retrospective case-control studiesAntibiotic therapy of E. Coli O157:H7 and the risk of HUSRisk of developing HUSA total of 1121 patients with E. coli O157:H7 enteritis were analyzed, of whom 175 developed HUS. Various antibiotics were usedThe odds ratio was 1.15 (95% CI 0.79-1/68)Recommended a prospective large RCT ADDIN EN.CITE <EndNote><Cite><Author>Proulx</Author><Year>1992</Year><RecNum>4431</RecNum><record><rec-number>4431</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Proulx, F.</author><author>Turgeon, J. P.</author><author>Delage, G.</author><author>Lafleur, L.</author><author>Chicoine, L.</author></authors></contributors><auth-address>Department of Pediatrics, Sainte-Justine Hospital, Universite de Montreal, Quebec, Canada.</auth-address><titles><title>Randomized, controlled trial of antibiotic therapy for Escherichia coli O157:H7 enteritis</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>299-303</pages><volume>121</volume><number>2</number><keywords><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Enteritis/ drug therapy/microbiology</keyword><keyword>Escherichia coli/classification/isolation &amp; purification</keyword><keyword>Escherichia coli Infections/complications/ drug therapy</keyword><keyword>Feces/microbiology</keyword><keyword>Female</keyword><keyword>Hemolytic-Uremic Syndrome/etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination/ therapeutic use</keyword></keywords><dates><year>1992</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>1640303</accession-num><urls></urls></record></Cite></EndNote>Proulx F, 1992Open-labelRCT47 children with E. coli O157:H7 enteritisRandomization 7.4 days after the onset of diarrheaT-S for 5 d vs no antibioticsLength of symptoms andFecal excretion, risk of developing HUSAntibiotics (vs no treatment) did not affect the resolution of clinical symptoms or bacterial eradication. The risk of HUS was 9% vs 16% ADDIN EN.CITE <EndNote><Cite><Author>Oberhelman</Author><Year>1987</Year><RecNum>6051</RecNum><record><rec-number>6051</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Oberhelman, R. A.</author><author>Javier de la Cabada, F.</author><author>Vasquez Garibay, E.</author><author>Bitsura, J. A.</author><author>DuPont, H. L.</author></authors></contributors><titles><title>Efficacy of trimethoprim-sulfamethoxazole in treatment of acute diarrhea in a Mexican pediatric population</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>960-5</pages><volume>110</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Clinical Trials</keyword><keyword>Diarrhea/ drug therapy/microbiology</keyword><keyword>Double-Blind Method</keyword><keyword>Drug Combinations/therapeutic use</keyword><keyword>Feces/microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Mexico</keyword><keyword>Placebos</keyword><keyword>Random Allocation</keyword><keyword>Sulfamethizole/ therapeutic use</keyword><keyword>Sulfathiazoles/ therapeutic use</keyword><keyword>Time Factors</keyword><keyword>Trimethoprim/ therapeutic use</keyword></keywords><dates><year>1987</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0022-3476 (Print)</isbn><accession-num>3295163</accession-num><urls></urls></record></Cite></EndNote>Oberhelman RA, 1987Double-blindRCT141 children with acute diarrhea, of whom 31 had enterotoxigenic E. coliTMP-SMX for 5 d vs placeboLength of symptoms andfecal excretionIN children with ETEC: significant (p<0.01) improvement in the clinical symptoms with antibiotics and in bacteriological efficacy ADDIN EN.CITE <EndNote><Cite><Author>Ericsson</Author><Year>1987</Year><RecNum>8536</RecNum><record><rec-number>8536</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ericsson, C. D.</author><author>Johnson, P. C.</author><author>Dupont, H. L.</author><author>Morgan, D. R.</author><author>Bitsura, J. A.</author><author>de la Cabada, F. J.</author></authors></contributors><titles><title>Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for travelers&apos; diarrhea. A placebo-controlled, randomized trial</title><secondary-title>Ann Intern Med</secondary-title></titles><periodical><full-title>Ann Intern Med</full-title></periodical><pages>216-20</pages><volume>106</volume><number>2</number><keywords><keyword>Adult</keyword><keyword>Ciprofloxacin/ therapeutic use</keyword><keyword>Clinical Trials</keyword><keyword>Diarrhea/ drug therapy/microbiology</keyword><keyword>Double-Blind Method</keyword><keyword>Drug Combinations/therapeutic use</keyword><keyword>Humans</keyword><keyword>Placebos</keyword><keyword>Prospective Studies</keyword><keyword>Random Allocation</keyword><keyword>Sulfamethoxazole/ therapeutic use</keyword><keyword>Time Factors</keyword><keyword>Travel</keyword><keyword>Trimethoprim/ therapeutic use</keyword><keyword>Trimethoprim-Sulfamethoxazole Combination</keyword></keywords><dates><year>1987</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0003-4819 (Print)</isbn><accession-num>3541724</accession-num><urls></urls></record></Cite></EndNote>Ericsson CD, 1987Double-blindRCT191 adults with travelers diarrhea were enrolled, of whom 73 had ETECCiprofloxacin or T-S or placebo for 5 daysLength of symptoms andFecal excretion, relapseClinical efficacy of both antibiotics: average h of diarrhea were 33, 26, and 84 (p<0.001). Bacteriologic efficacy also documented: fecal eradication rates were 100%, 100% and 71% ADDIN EN.CITE <EndNote><Cite><Author>Adachi</Author><Year>2003</Year><RecNum>8537</RecNum><record><rec-number>8537</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adachi, J. A.</author><author>Ericsson, C. D.</author><author>Jiang, Z. D.</author><author>DuPont, M. W.</author><author>Martinez-Sandoval, F.</author><author>Knirsch, C.</author><author>DuPont, H. L.</author></authors></contributors><auth-address>Center for Infectious Diseases, University of Texas-Houston School of Public Health and Medical School, Houston, Texas, USA.</auth-address><titles><title>Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico</title><secondary-title>Clin Infect Dis</secondary-title></titles><periodical><full-title>Clin Infect Dis</full-title></periodical><pages>1165-71</pages><volume>37</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Anti-Bacterial Agents/ therapeutic use</keyword><keyword>Anti-Infective Agents/therapeutic use</keyword><keyword>Azithromycin/ therapeutic use</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mexico</keyword><keyword>Ofloxacin/therapeutic use</keyword><keyword>Travel</keyword></keywords><dates><year>2003</year><pub-dates><date>Nov 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)</isbn><accession-num>14557959</accession-num><urls></urls></record></Cite></EndNote>Adachi JA, 2003Double-blindRCT217 adults with traveler’s diarrhea, of whom 110 had ETECAzithromycin 100 mg vs levofloxacin 500 mgdLength of symptoms andFecal excretionSimilar clinical efficacy of azithromycin and levofloxacin: duration of diarrhea 22.3 vs 21.5 h. Bacteriologic eradication 55% vs 61% ADDIN EN.CITE <EndNote><Cite><Author>Infante</Author><Year>2004</Year><RecNum>8538</RecNum><record><rec-number>8538</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Infante, R. M.</author><author>Ericsson, C. D.</author><author>Jiang, Z. D.</author><author>Ke, S.</author><author>Steffen, R.</author><author>Riopel, L.</author><author>Sack, D. A.</author><author>DuPont, H. L.</author></authors></contributors><auth-address>Center for Infectious Diseases, The University of Texas-Houston School of Public Health and Medical School, Houston, Texas, USA.</auth-address><titles><title>Enteroaggregative Escherichia coli diarrhea in travelers: response to rifaximin therapy</title><secondary-title>Clin Gastroenterol Hepatol</secondary-title></titles><periodical><full-title>Clin Gastroenterol Hepatol</full-title></periodical><pages>135-8</pages><volume>2</volume><number>2</number><keywords><keyword>Anti-Infective Agents/ therapeutic use</keyword><keyword>Diarrhea/ drug therapy/microbiology</keyword><keyword>Escherichia coli/ isolation &amp; purification/pathogenicity</keyword><keyword>Escherichia coli Infections/diagnosis/ drug therapy/microbiology</keyword><keyword>Humans</keyword><keyword>Rifamycins/ therapeutic use</keyword><keyword>Travel</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1542-3565 (Print)</isbn><accession-num>15017618</accession-num><urls></urls></record></Cite></EndNote>Infante RM, 2004Double-blindRCTAdults with traveler’s diarrhea caused by EaggECPO rifaximin vs placeboLength of symptoms Shorter duration of diarrhea with rifaximin: 22 vs 72 hours, (p=0.03) ADDIN EN.CITE <EndNote><Cite><Author>Thoren</Author><Year>1980</Year><RecNum>7426</RecNum><record><rec-number>7426</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thoren, A.</author><author>Wolde-Mariam, T.</author><author>Stintzing, G.</author><author>Wadstrom, T.</author><author>Habte, D.</author></authors></contributors><titles><title>Antibiotics in the treatment of gastroenteritis caused by enteropathogenic Escherichia coli</title><secondary-title>J Infect Dis</secondary-title></titles><periodical><full-title>J Infect Dis</full-title></periodical><pages>27-31</pages><volume>141</volume><number>1</number><keywords><keyword>Amdinocillin/ therapeutic use</keyword><keyword>Clinical Trials</keyword><keyword>Escherichia coli/classification</keyword><keyword>Escherichia coli Infections</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ drug therapy/etiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Penicillanic Acid/ therapeutic use</keyword><keyword>Serotyping</keyword><keyword>Sulfamethoxazole/adverse effects/ therapeutic use</keyword><keyword>Trimethoprim/adverse effects/ therapeutic use</keyword></keywords><dates><year>1980</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0022-1899 (Print)</isbn><accession-num>6245145</accession-num><urls></urls></record></Cite></EndNote>Thoren A, 1980Open-labelRCTAllocation concealment49 infants with EPEC diarrheaMecillinam vs T-S vs placeboLength of symptoms andFecal excretionBetter clinical response with both antimicrobial agents: 79% vs 73% vs 7% (p<o.001). Bacteriologic response: 53% for both antibiotic groups vs 0% (p<o.001).EPEC=enteropathogenic Escherichia coli; ETEC= Enterotoxigenic Escherichia coli; HUS=hemolytic-uremic syndrome; T-S=trimethoprim-sulfamethoxazole.Table 5.4.5.Antimicrobial therapy of parasite-induced gastroenteritisReferenceStudy type PopulationInterventionComparisonOutcome ADDIN EN.CITE <EndNote><Cite><Author>Vandenberg</Author><Year>2012</Year><RecNum>9147</RecNum><record><rec-number>9147</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vandenberg, O.</author><author>Robberecht, F.</author><author>Dauby, N.</author><author>Moens, C.</author><author>Talabani, H.</author><author>Dupont, E.</author><author>Menotti, J.</author><author>van Gool, T.</author><author>Levy, J.</author></authors></contributors><auth-address>Department of Microbiology, Saint-Pierre University Hospital and Jules Bordet Institute, Brussels, Belgium. olivier.vandenberg@ulb.ac.be</auth-address><titles><title>Management of a Cryptosporidium hominis outbreak in a day-care center</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>10-5</pages><volume>31</volume><number>1</number><keywords><keyword>Animals</keyword><keyword>Antiparasitic Agents/ therapeutic use</keyword><keyword>Belgium</keyword><keyword>Child Day Care Centers</keyword><keyword>Child, Preschool</keyword><keyword>Cryptosporidiosis/diagnosis/ drug therapy/parasitology/prevention &amp; control</keyword><keyword>Cryptosporidium/drug effects/genetics/ isolation &amp; purification</keyword><keyword>Diarrhea/diagnosis/ drug therapy/parasitology/prevention &amp; control</keyword><keyword>Disease Outbreaks/ prevention &amp; control</keyword><keyword>Feces/parasitology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hygiene</keyword><keyword>Infant</keyword><keyword>Infection Control/methods</keyword><keyword>Male</keyword><keyword>Paromomycin/therapeutic use</keyword><keyword>Polymerase Chain Reaction</keyword><keyword>Thiazoles/therapeutic use</keyword></keywords><dates><year>2012</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1532-0987 (Electronic)&#xD;0891-3668 (Linking)</isbn><accession-num>22094626</accession-num><urls></urls></record></Cite></EndNote>Vandenberg O, 2012Prospective cohort study130 children (3mo-3yr) attending a day-care center in BrusselsCollection of stool samples over-Our study underscores the need to rule out Cryptosporidium etiology in a diarrheal outbreak in a DCC. Rapid implementation of infection control measures can most likely halt the spread of infection ADDIN EN.CITE <EndNote><Cite><Author>Granados</Author><Year>2012</Year><RecNum>12462</RecNum><record><rec-number>12462</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Granados, C. E.</author><author>Reveiz, L.</author><author>Uribe, L. G.</author><author>Criollo, C. P.</author></authors></contributors><auth-address>Facultad de Medicina, Universidad Nacional de Colombia, Bogota D.C., Colombia.cegranadosg@unal.edu.co. caregra@.</auth-address><titles><title>Drugs for treating giardiasis</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD007787</pages><volume>12</volume><keywords><keyword>Adult</keyword><keyword>Albendazole/therapeutic use</keyword><keyword>Antiparasitic Agents/ therapeutic use</keyword><keyword>Child</keyword><keyword>Giardiasis/ drug therapy</keyword><keyword>Humans</keyword><keyword>Mebendazole/therapeutic use</keyword><keyword>Metronidazole/therapeutic use</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Thiazoles/therapeutic use</keyword><keyword>Tinidazole/therapeutic use</keyword></keywords><dates><year>2012</year></dates><isbn>1469-493X (Electronic)&#xD;1361-6137 (Linking)</isbn><accession-num>23235648</accession-num><urls></urls></record></Cite></EndNote>Granados CE, 2012MA (19 RCTs)1817 patients (1441 children) with giardiasis infectionAlbendazole (400 mg once daily for five to 10 days)metronidazole (250 mg to 500 mg three times daily for five to 10 days)Studies were generally small, with poor methods reporting. Albendazole may be of similar effectiveness to metronidazole, may have fewer side effects, and has the advantage of a simplified regimen. ADDIN EN.CITE <EndNote><Cite><Author>Escobedo</Author><Year>2008</Year><RecNum>10666</RecNum><record><rec-number>10666</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Escobedo, A. A.</author><author>Alvarez, G.</author><author>Gonzalez, M. E.</author><author>Almirall, P.</author><author>Canete, R.</author><author>Cimerman, S.</author><author>Ruiz, A.</author><author>Perez, R.</author></authors></contributors><auth-address>Department of Microbiology, Pediatric Academic Hospital &apos;Pedro Borras&apos;, 616 F. Plaza Havana City, 10400, Cuba. escobedo@infomed.sld.cu</auth-address><titles><title>The treatment of giardiasis in children: single-dose tinidazole compared with 3 days of nitazoxanide</title><secondary-title>Ann Trop Med Parasitol</secondary-title></titles><periodical><full-title>Ann Trop Med Parasitol</full-title></periodical><pages>199-207</pages><volume>102</volume><number>3</number><keywords><keyword>Abdominal Pain/parasitology</keyword><keyword>Adolescent</keyword><keyword>Antiparasitic Agents/ administration &amp; dosage</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cuba</keyword><keyword>Diarrhea/drug therapy/parasitology</keyword><keyword>Feces/parasitology</keyword><keyword>Female</keyword><keyword>Giardiasis/complications/ drug therapy</keyword><keyword>Humans</keyword><keyword>Thiazoles/ administration &amp; dosage</keyword><keyword>Tinidazole/ administration &amp; dosage</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2008</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0003-4983 (Print)&#xD;0003-4983 (Linking)</isbn><accession-num>18348774</accession-num><urls></urls></record></Cite></EndNote>Escobedo AA, 2008Controlled trial166 children infected with G. lamblia, with those oftinidazole, given as a single dose of 50 mg/kg. (63 completed the study)nitazoxanide, given at a dose of 7.5 mg/kg twice a day for 3 days. (74 completed the study)Cure rate: G. lamblia not found in both post-treatment samples: 90.5% Tinidazole vs 78.4% Nitazoxanide (P<0.05) ADDIN EN.CITE <EndNote><Cite><Author>Canete</Author><Year>2012</Year><RecNum>12463</RecNum><record><rec-number>12463</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Canete, R.</author><author>Rodriguez, P.</author><author>Mesa, L.</author><author>Brito, K.</author><author>Prior, A.</author><author>Guilhem, D.</author><author>Novaes, M. R.</author></authors></contributors><auth-address>Cuban Institute of Gastroenterology, Havana City, Cuba. roberto.villafranca@infomed.sld.cu</auth-address><titles><title>Albendazole versus metronidazole in the treatment of adult giardiasis: a randomized, double-blind, clinical trial</title><secondary-title>Curr Med Res Opin</secondary-title></titles><periodical><full-title>Curr Med Res Opin</full-title></periodical><pages>149-54</pages><volume>28</volume><number>1</number><keywords><keyword>Adult</keyword><keyword>Age of Onset</keyword><keyword>Albendazole/adverse effects/ therapeutic use</keyword><keyword>Antiprotozoal Agents/adverse effects/therapeutic use</keyword><keyword>Cuba/epidemiology</keyword><keyword>Double-Blind Method</keyword><keyword>Drug Administration Schedule</keyword><keyword>Giardiasis/ drug therapy/epidemiology</keyword><keyword>Humans</keyword><keyword>Metronidazole/adverse effects/ therapeutic use</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1473-4877 (Electronic)&#xD;0300-7995 (Linking)</isbn><accession-num>22114904</accession-num><urls></urls></record></Cite></EndNote>Canete R, 2012Double-blind, randomized, controlled trial150 Adults patients had a confirmed symptomatic G. duodenalis mono-infectionAlbendazole, 400 mg/daily for 5 days (75 pts)Metronidazole 250 x3/die for 5 days (75 pts)Cure rate: 82,6% vs 85,3 %, p>0.05 . Side effects : bitter taste, headache, vomiting and dizziness significantly higher in the Mentronidazole group. Abdominal pain significantly higher in Albendazole groupDCC=day-care center.Table 5.4.6 Antiviral treatmentReferenceStudy typeQoSCountryIn/OutPatientsPopulationRandomizationBlindingAllocation concealmentInterventionComparisonFUITTOutcomes measuresEffect measureEffect size (95% CI)Comments ADDIN EN.CITE <EndNote><Cite><Author>Guarino</Author><Year>1994</Year><RecNum>3895</RecNum><record><rec-number>3895</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Guarino, A.</author><author>Canani, R. B.</author><author>Russo, S.</author><author>Albano, F.</author><author>Canani, M. B.</author><author>Ruggeri, F. M.</author><author>Donelli, G.</author><author>Rubino, A.</author></authors></contributors><auth-address>Department of Pediatrics, University Federico II, Naples, Italy.</auth-address><titles><title>Oral immunoglobulins for treatment of acute rotaviral gastroenteritis</title><secondary-title>Pediatrics</secondary-title></titles><periodical><full-title>Pediatrics</full-title></periodical><pages>12-6</pages><volume>93</volume><number>1</number><keywords><keyword>Acute Disease</keyword><keyword>Administration, Oral</keyword><keyword>Child, Preschool</keyword><keyword>Double-Blind Method</keyword><keyword>Gastroenteritis/microbiology/ therapy</keyword><keyword>Humans</keyword><keyword>Immunoglobulins/ administration &amp; dosage</keyword><keyword>Infant</keyword><keyword>Prospective Studies</keyword><keyword>Rotavirus Infections/ therapy</keyword></keywords><dates><year>1994</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0031-4005 (Print)</isbn><accession-num>8265305</accession-num><urls></urls></record></Cite></EndNote>Guarino A, 1994RCT+ItalyInpatientsN=98 children with acute gastroenteritisAppropriateDouble-blindedNot clearSingle?oral?dose of 300 mg/kg body weight of human serum immunoglobulinPlacebo98/98YesMean duration of diarrhea (h)Number76 vs 131 (p<0.01)Consistent evidence demonstrated that oral administration of immunoglobulin (300 mg/kg) may be beneficial for rotaviral infection and is associated with a faster recovery from acute diarrhea Viral excretion (h)Number114 vs 180 (p<0.01)Hospital stay (h)-*reduced in treated chilren ADDIN EN.CITE <EndNote><Cite><Author>Sarker</Author><Year>1998</Year><RecNum>2672</RecNum><record><rec-number>2672</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sarker, S. A.</author><author>Casswall, T. H.</author><author>Mahalanabis, D.</author><author>Alam, N. H.</author><author>Albert, M. J.</author><author>Brussow, H.</author><author>Fuchs, G. J.</author><author>Hammerstrom, L.</author></authors></contributors><auth-address>International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh. sasarker@cis.</auth-address><titles><title>Successful treatment of rotavirus diarrhea in children with immunoglobulin from immunized bovine colostrum</title><secondary-title>Pediatr Infect Dis J</secondary-title></titles><periodical><full-title>Pediatr Infect Dis J</full-title></periodical><pages>1149-54</pages><volume>17</volume><number>12</number><keywords><keyword>Administration, Oral</keyword><keyword>Animals</keyword><keyword>Antibodies, Viral/immunology</keyword><keyword>Cattle</keyword><keyword>Child, Preschool</keyword><keyword>Colostrum/immunology</keyword><keyword>Diarrhea, Infantile/ drug therapy/virology</keyword><keyword>Double-Blind Method</keyword><keyword>Drug Administration Schedule</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Immunoglobulins/ administration &amp; dosage</keyword><keyword>India</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Prognosis</keyword><keyword>Rotavirus Infections/diagnosis/ drug therapy</keyword><keyword>Statistics, Nonparametric</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>1998</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0891-3668 (Print)</isbn><accession-num>9877365</accession-num><urls></urls></record></Cite></EndNote>Sarker SA, 1998RCT+BangladeshInpatientsN=85 male infants and children aged 4 to 24 months with a history of acute watery diarrhea AppropriateDouble-blindedAppropriateImmunoglobulin from immunized bovine colostrum (10 g in 20ml of water in 4 divided doses for 4 days)Placebo80/85NoStool rate (grams/kg/day)Mean±SDDay 1 (P?= 0.006), Day 2 (0.006) and Day 3 (0.02)Intake of ORS (ml/kg/day)Mean±SD281±30 vs 410±39; p<0.001Stool frequency (number/days 1-4)Number29 vs 42; p=0.007Number of days required for RV ELISA-negative stool (days)Mean±SD1.5 vs. 2.9, P < 0.001Duration of diarrhea after initiation of therapy (h)Mean±SD72.6±38.9 vs 96.4±46.7; p=0.0016 ADDIN EN.CITE <EndNote><Cite><Author>Rahman</Author><Year>2012</Year><RecNum>8954</RecNum><record><rec-number>8954</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rahman, S.</author><author>Higo-Moriguchi, K.</author><author>Htun, K. W.</author><author>Taniguchi, K.</author><author>Icatlo, F. C., Jr.</author><author>Tsuji, T.</author><author>Kodama, Y.</author><author>Van Nguyen, S.</author><author>Umeda, K.</author><author>Oo, H. N.</author><author>Myint, Y. Y.</author><author>Htut, T.</author><author>Myint, S. S.</author><author>Thura, K.</author><author>Thu, H. M.</author><author>Fatmawati, N. N.</author><author>Oguma, K.</author></authors></contributors><auth-address>Immunology Research Institute in Gifu, EW Nutrition Japan, 839-7 Sano, Gifu 501-1101, Japan. shofiq66@</auth-address><titles><title>Randomized placebo-controlled clinical trial of immunoglobulin Y as adjunct to standard supportive therapy for rotavirus-associated diarrhea among pediatric patients</title><secondary-title>Vaccine</secondary-title></titles><periodical><full-title>Vaccine</full-title></periodical><pages>4661-9</pages><volume>30</volume><number>31</number><keywords><keyword>Animals</keyword><keyword>Chickens</keyword><keyword>Diarrhea, Infantile/ drug therapy/virology</keyword><keyword>Female</keyword><keyword>Fluid Therapy</keyword><keyword>Humans</keyword><keyword>Immunoglobulins/ therapeutic use</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Mice</keyword><keyword>Rotavirus</keyword><keyword>Rotavirus Infections/ drug therapy/virology</keyword><keyword>Virus Shedding</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun 29</date></pub-dates></dates><isbn>1873-2518 (Electronic)&#xD;0264-410X (Linking)</isbn><accession-num>22575165</accession-num><urls></urls></record></Cite></EndNote>Rahman S, 2012RCT+MyanmarInpatientsN=54 infants and children aged between 2 and36months with acute watery diarrhea and dehydrationAppropriateDouble-blindedAppropriateRotamix IgY four times daily for 8 consecutive days in addition to rehydration therapyPlacebo52/54YesIntake of ORS (ml)Mean±SD699.3±111.1 vs. 919.1±171.31, p=0.004Oral administration of IgY could improve clinical outcomes (ORS intake, and duration of IV administration, of diarrhea, and of RV clearance), even for patients with mixed (RV and non-RV) enteric infections, and is a potentially useful adjunct to general supportive therapy in pediatric patients Mean duration of intravenous ?uid administration (days)Mean 5 vs 8; p=0.03No. of stools/day (day 2)Mean±SD6.7±4.3 vs 10.2±8.8 (p=0.03)Total duration of diarrhea from day of admission (h)Mean±SD135.3±42.0 vs 185.5±41.7; p=0.01 ADDIN EN.CITE <EndNote><Cite><Author>Florescu</Author><Year>2011</Year><RecNum>9239</RecNum><record><rec-number>9239</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Florescu, D. F.</author><author>Hermsen, E. D.</author><author>Kwon, J. Y.</author><author>Gumeel, D.</author><author>Grant, W. J.</author><author>Mercer, D. F.</author><author>Kalil, A. C.</author></authors></contributors><auth-address>Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA. dflorescu@unmc.edu</auth-address><titles><title>Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients?</title><secondary-title>Pediatr Transplant</secondary-title></titles><periodical><full-title>Pediatr Transplant</full-title></periodical><pages>718-21</pages><volume>15</volume><number>7</number><keywords><keyword>Administration, Oral</keyword><keyword>Adolescent</keyword><keyword>Biopsy</keyword><keyword>Caliciviridae Infections/ immunology/ therapy</keyword><keyword>Case-Control Studies</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Gastroenteritis/ immunology/ therapy</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Immunoglobulins/administration &amp; dosage/ therapeutic use</keyword><keyword>Immunosuppression</keyword><keyword>Infant</keyword><keyword>Intestines/transplantation</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Norovirus/ metabolism</keyword><keyword>Tacrolimus/therapeutic use</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1399-3046 (Electronic)&#xD;1397-3142 (Linking)</isbn><accession-num>21883746</accession-num><urls></urls></record></Cite></EndNote>Florescu DF, 2011Case-control study+USAInpatientsN=24 immunocompromised patients (16 children) diagnosed with NV gastroenteritis---25 mg/kg of oral human immunoglobulin administered every six h for a total of eight doses in adjunct to standard therapyControls--Resolution of diarrheaOR65.3; p=0.008Oral immunoglobulin treatment has been proposed for NV enteritis. Resolution of diarrhea and decreased stool output were observed at 7 days, but no benefit was found for length of hospital stay or hospital cost Stool output seven days after treatment (mL/kg/day)Mean-22.15 vs -10.20; p=0.009NV=Norovirus; OR=odds ratio; ORS=Oral rehydration solution; QoS=Quality of Study; RV=Rotavirus.Table 5.4. NitazoxanideReference InterventionRandomizationAllocation concealmentBlindingITT analysisPopulationMain results(experimental group vs. control group) ADDIN EN.CITE <EndNote><Cite><Author>Teran</Author><Year>2009</Year><RecNum>10396</RecNum><record><rec-number>10396</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Teran, C. G.</author><author>Teran-Escalera, C. N.</author><author>Villarroel, P.</author></authors></contributors><auth-address>Pediatric Center Albina Patino, Department of Infectious Disease, Calle Jordan 822, Cochabamba, Bolivia. carteran79@</auth-address><titles><title>Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children</title><secondary-title>Int J Infect Dis</secondary-title></titles><periodical><full-title>Int J Infect Dis</full-title></periodical><pages>518-23</pages><volume>13</volume><number>4</number><keywords><keyword>Antiviral Agents/therapeutic use</keyword><keyword>Bolivia</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Diarrhea/ drug therapy</keyword><keyword>Drug Therapy, Combination</keyword><keyword>Fluid Therapy/methods</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Probiotics/ therapeutic use</keyword><keyword>Rotavirus Infections/ drug therapy</keyword><keyword>Single-Blind Method</keyword><keyword>Thiazoles/ therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1878-3511 (Electronic)&#xD;1201-9712 (Linking)</isbn><accession-num>19070525</accession-num><urls></urls></record></Cite></EndNote>Teran CG, 2009Nitazoxanide 15 mg/kg/d for 3 days vs. placebo AdequateUnclearSBNo (ACA)N=75 (1-24 mo)Reduced duration of diarrhea (52.9±27.7 vs. 74.6±26.6 h; MD -21.7 h, 95% CI -34.74 to -8.66).Reduced duration of hospitalization (81.8±30.8 vs. 100.9±27.3; MD -19.1 h; 95% CI -33.27 to -4.93).ACA=available case analysis; CI=confidence interval; MD=Median duration.Bibliography ADDIN EN.REFLIST Abba K, Sinfield R, Hart CA, et al. 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