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.
abstract: BACKGROUND
  A high proportion of children with persistent diarrhoea in middle and low income countries die. The best treatment is not clear. We conducted a systematic review to evaluate the effectiveness of antimicrobial drug treatment for persistent diarrhoea of unknown or non-specific cause.
  
  
  METHODS
  We included randomized comparisons of antimicrobial drugs for the treatment of persistent diarrhoea of unknown or non-specific cause in children under the age of six years in low and middle income countries. We searched the electronic databases MEDLINE, EMBASE, LILACS, WEB OF SCIENCE, and the Cochrane Central Register of Controlled Trials (CENTRAL) to May 2008 for relevant randomized or quasi randomized controlled trials. We summarised the characteristics of the eligible trials, assessed their quality using standard criteria, and extracted relevant outcomes data. Where appropriate, we combined the results of different trials.
  
  
  RESULTS
  Three trials from South East Asia and one from Guatemala were included, all were small, and three had adequate allocation concealment. Two were in patients with diarrhoea of unknown cause, and two were in patients in whom known bacterial or parasitological causes of diarrhoea had been excluded. No difference was demonstrated for oral gentamicin compared with placebo (presence of diarrhoea at 6 or 7 days; 2 trials, n = 151); and for metronidazole compared with placebo (presence of diarrhoea at 3, 5 and 7 days; 1 trial, n = 99). In one small trial, sulphamethoxazole-trimethoprim appeared better than placebo in relation to diarrhoea at seven days and total stool volume (n = 55).
  
  
  CONCLUSIONS
  There is little evidence as to whether or not antimicrobials help treat persistent diarrhoea in young children in low and middle income countries.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. K.abba@liverpool.ac.uk
authors.forename: Katharine
authors.initials: K
authors.lastname: Abba
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sinfield
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Hart
authors.forename: Paul
authors.initials: P
authors.lastname: Garner
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001210:Asia, Southeastern / Q000453:epidemiology; D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology; D005839:Gentamicins / Q000627:therapeutic use; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008795:Metronidazole / Q000627:therapeutic use; D011203:Poverty; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D005839:Gentamicins; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination