title: European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014.
abstract: OBJECTIVE
  These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe.
  
  
  METHODS
  The guideline development group formulated questions, identified data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system.
  
  
  RESULTS
  Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates.
  
  
  CONCLUSIONS
  Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.
authors.affiliation: *Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy †Schneider Children's Medical Center, Tel-Aviv University, Tel-Aviv, Israel ‡University Paris 5 and Necker-Enfants-Malades, Paris, France §Medical University of Warsaw, Department of Pediatrics, Warsaw, Poland.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
authors.forename: Dominique
authors.initials: D
authors.lastname: Gendrel
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Hania
authors.initials: H
authors.lastname: Szajewska
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003967:Diarrhea / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition; D005060:Europe; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010288:Parenteral Nutrition; D019936:Probiotics / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents; D000930:Antidiarrheals; D000932:Antiemetics