Zubairi Mustafa Bin Ali, Naqvi Syeda Kanza, Ali Ayesha Arshad, Sharif Ashraf, Salam Rehana Abdus, Hasnain Zain, Soofi Sajid, Ariff Shabina, Nisar Yasir Bin, Das Jai K
Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan.
University Library, Aga Khan University, Karachi, Pakistan.
J Glob Health. 2024 Dec 6;14:04166. doi: 10.7189/jogh.14.04166.
Oral rehydration solution (ORS) is crucial in the management of diarrhoea. Until the early 2000s, the standard formulation of glucose-based ORS with a total osmolarity of 311 mmol/L was being used for this purpose. However, due to concerns about sodium levels and cases of hypernatremia, a low-osmolarity ORS solution (LORS) with an osmolarity of 245mmol/L or less was developed to replace the standard ORS. With this systematic review, we aimed to assess the effectiveness of LORS compared to standard ORS for the treatment of acute and persistent diarrhoea.
We comprehensively searched PubMed, CINAHL, the Cochrane Library, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform, and Scopus until 20 July 2023 for studies published after 1990 assessing the efficacy of LORS in acute and persistent diarrhoea in children under 10 years of age. Meta-analysis was conducted using the RevMan software. We performed log approximation for all the values for an outcome when studies reported arithmetic and geometric means per the Cochrane Handbook. We otherwise used the Cochrane Risk of Bias II tool to assess the risk of bias in individual studies, and assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations approach. This review was commissioned by the WHO for revision of guidelines for childhood diarrhoea.
For the comparison of LORS to standard ORS in acute diarrhoea, our findings suggest that there was a significant decrease in the duration of diarrhoea (mean difference (MD) = -0.28; 95% confidence interval (CI) = -0.41, -0.15; moderate certainty of evidence), stool output (MD = -0.25; 95% CI = -0.35, -0.16; very low certainty of evidence), and ORS intake (MD = -0.18; 95% CI = -0.28, -0.07; moderate certainty of evidence) in patients receiving LORS. There was a comparable effect on the number of patients cured within five days, treatment failure, and frequency of unscheduled intravenous therapy (risk ratio (RR) = 0.77; 95% CI = 0.72, 9.38; low certainty of evidence). For persistent diarrhoea, there was a significant decrease in duration of diarrhoea (MD = -30.60; 95% CI = -48.95, -12.25), stool output (MD = -14.00; 95% CI = -26.63, -1.37), and ORS intake (MD = -21.40; 95% CI = -41.01, -1.79), while there was a comparable effect on the number of patients cured.
Our findings suggest that LORS should continue to be recommended in children under the age of 10 years with acute watery or persistent diarrhoea and upholds the current WHO recommendations.
PROSPERO: CRD42023438762.
口服补液盐（ORS）在腹泻治疗中至关重要。直到21世纪初，总渗透压为311 mmol/L的基于葡萄糖的标准ORS制剂一直用于此目的。然而，由于对钠水平和高钠血症病例的担忧，开发了一种渗透压为245mmol/L或更低的低渗ORS溶液（LORS）来取代标准ORS。通过本系统评价，我们旨在评估LORS与标准ORS相比治疗急性和持续性腹泻的有效性。
我们全面检索了PubMed、CINAHL、Cochrane图书馆、ClinicalTrials.gov、世界卫生组织（WHO）国际临床试验注册平台和Scopus，直至2023年7月20日，以查找1990年后发表的评估LORS对10岁以下儿童急性和持续性腹泻疗效的研究。使用RevMan软件进行荟萃分析。当研究根据Cochrane手册报告算术均值和几何均值时，我们对结果的所有值进行对数近似。否则，我们使用Cochrane偏倚风险II工具评估个体研究中的偏倚风险，并使用推荐分级、评估、制定和评价方法评估证据质量。本评价由WHO委托进行，以修订儿童腹泻指南。
对于急性腹泻中LORS与标准ORS的比较，我们的研究结果表明，接受LORS的患者腹泻持续时间（平均差（MD）=-0.28；95%置信区间（CI）=-0.41，-0.15；中等证据确定性）、粪便排出量（MD=-0.25；95%CI=-0.35，-0.16；极低证据确定性）和ORS摄入量（MD=-0.18；95%CI=-0.28，-0.07；中等证据确定性）均显著降低。在五天内治愈的患者数量、治疗失败和非计划静脉治疗频率方面有类似效果（风险比（RR）=0.77；95%CI=0.72，9.38；低证据确定性）。对于持续性腹泻，腹泻持续时间（MD=-30.60；95%CI=-48.95，-12.25）、粪便排出量（MD=-14.00；95%CI=-26.63，-1.37）和ORS摄入量（MD=-21.40；95%CI=-41.01，-1.79）均显著降低，而在治愈患者数量方面有类似效果。
我们的研究结果表明，对于10岁以下患有急性水样或持续性腹泻的儿童，应继续推荐使用LORS，这支持了WHO目前的建议。
PROSPERO：CRD42023438762。
