Meta-analysis: Smectite in the treatment of acute infectious diarrhoea in children.
BACKGROUND
Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrhoea in many countries.


OBJECTIVE
To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhoea in children.


METHODS
Using medical subject headings and free-language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhoea and smectite: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials were included.


RESULTS
Nine randomized-controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized-controlled trials showed that smectite significantly reduced the duration of diarrhoea compared with placebo. The pooled weighted mean difference was (-22.7 h, 95% CI: -24.8 to -20.6) with a fixed model and remained significant in a random effect model (-24.4 h, 95% CI: -29.8 to -19.1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1.64, 95% CI: 1.36-1.98; number needed to treat 4, 95% CI: 3-5). Adverse effects were similar in both groups.


CONCLUSIONS
Smectite may be a useful adjunct to rehydration therapy in treating acute paediatric gastroenteritis. However, the results of this meta-analysis should be interpreted with caution as most of the included studies had important limitations. Cost-effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended.
Szajewska
H
H
Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland. hania@ipgate.pl
Dziechciarz
P
P
Mrukowicz
J
J
D000208:Acute Disease; D000293:Adolescent; D000930:Antidiarrheals / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy*; D005243:Feces; D005759:Gastroenteritis / Q000188:drug therapy; D006801:Humans; D007223:Infant; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D017640:Silicates / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000150:complications
D000930:Antidiarrheals; D017640:Silicates; C033214:Smectite