title: The management of acute diarrhea in children in developed and developing areas: from evidence base to clinical practice.
abstract: BACKGROUND
  Acute diarrhea remains a major problem in children and is associated with substantial morbidity, mortality and costs. While vaccination against rotavirus could reduce the burden of the disease, the persistent impact of intestinal infections requires effective treatment in adjunct to oral rehydration solutions, to reduce the severity and duration of diarrhea. Several therapeutic options have been proposed for acute diarrhea, but proof of efficacy is available for few of them, including zinc, diosmectite, selected probiotics and racecadotril. However, at present there is no universal drug, and therapeutic efficacy has only been shown for selected drugs in selected settings, such as: outpatients/inpatients, developed/developing countries and viral/bacterial etiology.
  
  
  METHODS
  This narrative review reports the opinions of experts from different countries of the world who have discussed strategies to improve the management of diarrhea.
  
  
  CONCLUSIONS
  More data are needed to optimize the management of diarrhea and highlight the research priorities at a global level; such priorities include improved recommendations on oral rehydration solution composition, and the reevaluation of therapeutic options in the light of new trials. Therapeutic strategies need to be assessed in different settings, and pharmacoeconomic analyses based on country-specific data are needed. Transfer to clinical practice should result from the implementation of guidelines tailored at a local level, with an eye on costs.
authors: Universsity of Naples Federico II, Department of Pediatrics, Via Pansini 5, 80131 Naples, Italy. alfguari@unina.it
authors: Alfredo
authors: A
authors: Guarino
authors: Christophe
authors: C
authors: Dupont
authors: Alexander V
authors: AV
authors: Gorelov
authors: Frederic
authors: F
authors: Gottrand
authors: Jimmy K F
authors: JK
authors: Lee
authors: Zhihong
authors: Z
authors: Lin
authors: Andrea
authors: A
authors: Lo Vecchio
authors: Thien D
authors: TD
authors: Nguyen
authors: Eduardo
authors: E
authors: Salazar-Lindo
mesh_terms: D000208:Acute Disease; D002648:Child; D003365:Costs and Cost Analysis; D003906:Developing Countries; D003967:Diarrhea / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D005060:Europe; D005759:Gastroenteritis / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D006801:Humans