دورية أكاديمية
أعرض في EDS

Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis.

التفاصيل البيبلوغرافية
العنوان: Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis.
المؤلفون: Florez ID; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia., Veroniki AA; Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Canada.; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece., Al Khalifah R; Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia., Yepes-Nuñez JJ; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia., Sierra JM; Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia., Vernooij RWM; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands., Acosta-Reyes J; Department of Public Health, Universidad del Norte, Barranquilla, Colombia., Granados CM; Department of Clinical Epidemiology & Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia., Pérez-Gaxiola G; Hospital Pediátrico de Sinaloa, Culiacán, Mexico., Cuello-Garcia C; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Department of Pediatrics, McMaster University, Hamilton, Canada., Zea AM; School of Nutrition and Dietetics, University of Antioquia, Medellin, Colombia., Zhang Y; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada., Foroutan N; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Programs for Assessment of Technology in Health (PATH), St. Joseph Health Care Hamilton, Hamilton, Canada., Guyatt GH; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Thabane L; Department of Health Research Methods, Evidence & Impact; McMaster University, Hamilton, Canada.; Department of Pediatrics, McMaster University, Hamilton, Canada.; Department of Anaesthesia, McMaster University, Hamilton, Canada.
المصدر: PloS one [PLoS One] 2018 Dec 05; Vol. 13 (12), pp. e0207701. Date of Electronic Publication: 2018 Dec 05 (Print Publication: 2018).
نوع المنشور: Journal Article; Meta-Analysis; Systematic Review
اللغة: English
بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
أسماء مطبوعة: Original Publication: San Francisco, CA : Public Library of Science
مواضيع طبية MeSH: Diarrhea/*therapy , Gastroenteritis/*therapy, Antidiarrheals/therapeutic use ; Bayes Theorem ; Child ; Humans ; Loperamide/therapeutic use ; Network Meta-Analysis ; Prebiotics ; Probiotics/therapeutic use ; Saccharomyces boulardii ; Treatment Outcome ; Zinc/therapeutic use
مستخلص: Background: Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of ADG in children.
Methods: Data sources included Medline, Embase, CENTRAL, CINAHL, LILACS, and Global-Health up to May 2017. Eligible trials compared zinc (ZN), vitamin A, micronutrients (MN), probiotics, prebiotics, symbiotics, racecadotril, smectite(SM), loperamide, diluted milk, lactose-free formula(LCF), or their combinations, to placebo or standard treatment (STND), or among them. Two reviewers independently performed screening, review, study selection and extraction. The primary outcome was diarrhea duration. Secondary outcomes were stool frequency at day 2, diarrhea at day 3, vomiting and side effects. We performed a random effects Bayesian network meta-analysis to combine the direct and indirect evidence for each outcome. Mean differences and odds ratio with their credible intervals(CrI) were calculated. Coherence and transitivity assumptions were assessed. Meta-regression, subgroups and sensitivity analyses were conducted to explore the impact of effect modifiers. Summary under the cumulative curve (SUCRA) values with their CrI were calculated. We assessed the evidence quality and classified the best interventions using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach for each paired comparison.
Results: A total of 174 studies (32,430 children) proved eligible. Studies were conducted in 42 countries of which most were low-and middle-income countries (LMIC). Interventions were grouped in 27 categories. Most interventions were better than STND. Reduction of diarrhea varied from 12.5 to 51.1 hours. The combinations Saccharomyces boulardii (SB)+ZN, and SM+ZN were considered the best interventions (i.e., GRADE quality of evidence: moderate to high, substantial superiority to STND, reduction in duration of 35 to 40 hours, and large SUCRA values), while symbiotics (combination of probiotics+prebiotics), ZN, loperamide and combinations ZN+MN and ZN+LCF were considered inferior to the best and better than STND [Quality: moderate to high, superior to STND, and reduction of 17 to 25 hours]. In subgroups analyses, effect of ZN was higher in LMIC and was not present in high-income countries (HIC). Vitamin A, MN, prebiotics, kaolin-pectin, and diluted milk were similar to STND [Quality: moderate to high]. The remainder of the interventions had low to very-low evidence quality. Loperamide was the only intervention with more side effects than STND [Quality: moderate].
Discussion/conclusion: Most interventions analyzed (except vitamin A, micronutrients, prebiotics, and kaolin-pectin) showed evidence of superiority to placebo in reducing the diarrhea. With moderate-to high-quality of evidence, SB+ZN and SM+ZN, demonstrated the best combination of evidence quality and magnitude of effect while symbiotics, loperamide and zinc proved being the best single interventions, and loperamide was the most unsafe. Nonetheless, the effect of zinc, SB+ZN and SM+ZN might only be applied to children in LMIC. Results suggest no further role for studies comparing interventions against no treatment or placebo, or studies testing loperamide, MN, kaolin-pectin, vitamin A, prebiotics and diluted milk.
Prospero Registration: CRD42015023778.
Competing Interests: The authors have declared that no competing interests exist.
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المشرفين على المادة: 0 (Antidiarrheals)
0 (Prebiotics)
6X9OC3H4II (Loperamide)
J41CSQ7QDS (Zinc)
تواريخ الأحداث: Date Created: 20181206 Date Completed: 20190506 Latest Revision: 20240405
رمز التحديث: 20240405
مُعرف محوري في PubMed: PMC6281220
DOI: 10.1371/journal.pone.0207701
PMID: 30517196
قاعدة البيانات: MEDLINE
الوصف
تدمد:1932-6203
DOI:10.1371/journal.pone.0207701