title: Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children.
abstract: Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines.
  
  
  
  CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs.
  
  
  
  The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na 45-60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged.
  
  
  
  Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.
authors.affiliation: *Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy †Departamento de Pediatria Médica, Hospital de São João, Porto, Portugal ‡KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya §Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ||Department of Pediatrics, University of Alabama at Birmingham, Birmingham ¶INTA, Universidad de Chile, Macul, Chile #Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru **Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom ††Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada ‡‡Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.forename: Chris
authors.initials: C
authors.lastname: Boey
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Cohen
authors.forename: Sylvia
authors.initials: S
authors.lastname: Cruchet
authors.forename: Ilaria
authors.initials: I
authors.lastname: Liguoro
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salazar Lindo
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Sandhu
authors.forename: Philip
authors.initials: P
authors.lastname: Sherman
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D000208:Acute Disease; D002648:Child; D005759:Gastroenteritis / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic
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