Guidelines, when followed, work for management of acute gastroenteritis

Article Outline

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There are many published studies of effect of single interventions (eg, rehydration solutions, diet, medications) on the course of acute gastroenteritis. The study reported in this issue of The Journal by Albano et al from Naples is different. It assessed efficacy of a global guideline in a randomized control study by provider. Investigators took the four major intervention tenets proposed by the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition, randomly assigned pediatricians to a control group for management of acute gastroenteritis, or a 2-hour educational intervention group, and then assessed outcomes of approximately 1300 children managed by these 150 pediatricians.

Guideline-educated pediatricians were asked to adhere to all four major tenets of guidelines – rapid oral rehydration for 3 to 4 hours with hypo-osmolar solution, re-feeding normal diet after 4 hours or rehydration, and avoidance of any medications or microbiologic testing. Sixty-six percent of cases managed by guideline-educated pediatricians were fully adherent to the major tenets, compared with only 3% of those managed by control-group pediatricians. Duration of diarrhea was shorter and weight gain greater in guideline-treated children, especially in treatment-per-protocol analysis. Major violation of guidelines in both intervention and control groups were dietary restrictions and administration of anti-diarrheal medications.

The study confirms efficacy of global guidelines for management of acute gastroenteritis, which are easy to teach, less expensive to carry out than “unguided” management, and which may avoid deleterious effects of unnecessary drugs. Now, to educate physicians and convince parents to change habit and culture surrounding care of children with diarrhea.