Fang You-Hong, Wan Chao-Min, Gong Si-Tang, Fang Feng, Sun Mei, Qian Yuan, Huang Ying, Wang Bao-Xi, Xu Chun-Di, Jin Yu, Ye Li-Yan, Shu Sai-Nan, Wu Qing-Bin, Wu Jie, Li Xiao-Qin, Chen Jing-Fang, Xu Hong-Mei, Li Zheng-Hong, Yu Hui, Deng Ji-Kui, Chen Jie
Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China.
Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China.
World J Pediatr. 2025 May 29. doi: 10.1007/s12519-025-00894-7.
Some new progress and evidence have been made in the diagnosis and treatment of pediatric acute infectious diarrhea since the publication of the "Chinese clinical practice guidelines for acute infectious diarrhea in children" (2018 edition guidelines). The updated "Chinese clinical practice guidelines for acute infectious diarrhea in children" incorporates new evidence-based recommendations for managing acute infectious diarrhea in the Chinese pediatric population.
Building on the 2018 edition guidelines, expert panels reviewed clinical evidence, assessed preliminary recommendations, and conducted open-ended discussions to finalize the updated guidelines. These guidelines are founded on the latest literature and evidence-based practices. A literature review was performed in databases such as PubMed, Cochrane, EMBASE, China Biomedical Database, and the Chinese Journal Full-text Database up to June 2024. The search focused on the terms "acute diarrhea" or "enteritis", along with "adolescent", "child", "pediatric patient", "baby", or "infant".
The updated guidelines address various aspects of acute infectious diarrhea, including diagnosis, etiological evaluation, dehydration assessment, fluid therapy, diet therapy, medical therapy, and prevention strategies. The main updates focused on etiological diagnosis and the use of probiotics, racecadotril, zinc, and antibiotics in treating acute infectious diarrhea.
The updated guidelines address disputed treatments for acute infectious diarrhea through evidence-based revisions. Standardized etiological evaluations guide management. Probiotics are moderately advised for viral watery diarrhea; racecadotril remains unsupported. Zinc supplementation is recommended for children >6 months in deficient regions. Antibiotics are restricted to cases with dysenteric-like symptoms, suspected cholera with severe dehydration, or comorbidities.
自《中国儿童急性感染性腹泻病临床实践指南（2018年版）》发布以来，儿童急性感染性腹泻的诊断和治疗取得了一些新进展和证据。更新后的《中国儿童急性感染性腹泻病临床实践指南》纳入了针对中国儿童急性感染性腹泻管理的新的循证建议。
在2018年版指南的基础上，专家小组审查了临床证据，评估了初步建议，并进行了开放式讨论以最终确定更新后的指南。这些指南基于最新文献和循证实践。截至2024年6月，在PubMed、Cochrane、EMBASE、中国生物医学数据库和中国期刊全文数据库等数据库中进行了文献综述。检索重点是“急性腹泻”或“肠炎”，以及“青少年”“儿童”“儿科患者”“婴儿”或“幼儿”等术语。
更新后的指南涉及急性感染性腹泻的各个方面，包括诊断、病因评估、脱水评估、液体疗法、饮食疗法、药物治疗和预防策略。主要更新集中在病因诊断以及益生菌、消旋卡多曲、锌和抗生素在治疗急性感染性腹泻中的应用。
更新后的指南通过循证修订解决了急性感染性腹泻存在争议的治疗方法。标准化的病因评估指导治疗。对于病毒性水样腹泻，适度建议使用益生菌；消旋卡多曲仍然缺乏支持。在缺锌地区，建议对6个月以上儿童补充锌。抗生素仅限于有痢疾样症状、疑似霍乱伴严重脱水或合并症的病例。
