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Smectite for acute diarrhoea in children
  1. Zui-Shen Yen, Emergency Physician,
  2. Mei-Shu Lai, Emergency Physician
  1. National Taiwan University Hospital, Taiwan

    Abstract

    A short cut review was carried out to establish whether smectite was a useful therapy in acute diarrhoea. A total of 21 papers were found of which five presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. The clinical bottom line is that oral smectite appears to be effective at shortening the duration of the diarrhoea in children with acute diarrhoea rehydrated with oral rehydration solution.

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    Report by Zui-Shen Yen, Emergency PhysicianChecked by Mei-Shu Lai, Emergency PhysicianNational Taiwan University Hospital, Taiwan

    Three part question

    In [children with acute diarrhoea] is [the use of smectite with oral rehydration solution better than oral rehydration solution alone] at [shortening the duration of diarrhoea]?

    Clinical scenario

    A 12 month old boy with acute diarrhoea is brought to the emergency department by his parents. He tolerates oral rehydration solution well but his parents still worry very much about his frequent loose stools. You wonder if the use of smectite would provide any additional benefit.

    Search strategy

    Medline 1966–August 2005, Embase 1966–August 2005: {(dioctahedral$.mp OR smect$.mp) AND (exp diarrhea OR exp gastroenteritis OR diarrh$.mp)} LIMIT to human AND English. Embase: {(diactahedral* OR smect*) AND (‘diarrhea’/exp OR ‘gastroenteritis’/exp OR diarrh*)} LIMIT to human AND English; Cochrane Library: [smectite]

    Search outcome

    Medline and Embase: 21 papers were found, of which five were considered to be original research of high quality (randomised controlled trials) and relevant to the topic of interest (table 4). No additional citations were found in the Cochrane Library.

    Table 4

    Comment(s)

    Dioctahedral smectite is a natural adsorbent clay formed of fine sheets of aluminomagnesium silicate. Smectite has been found to adsorb viruses, bacteria, and bacterial toxins, thus protecting the intestinal mucosa. Most of the clinical studies in table 4 were relatively small and only one was obviously blinded. However, they consistently showed the efficacy of smectite in reducing the duration of diarrhoea. In children with acute diarrhoea rehydrated with oral rehydration solution, smectite may shorten the duration of diarrhoea by about 20–50%. No significant side effects were observed. Considering the safety, tolerance and antidiarrhoeal activity of smectite, it is worth a try in the treatment of acute diarrhoea in children.

    CLINICAL BOTTOM LINE

    Oral smectite appears to be effective at shortening the duration of diarrhoea in children with acute diarrhoea rehydrated with oral rehydration solution.

    Report by Zui-Shen Yen, Emergency PhysicianChecked by Mei-Shu Lai, Emergency PhysicianNational Taiwan University Hospital, Taiwan

    References

    View Abstract

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