Oral rehydration solution with zinc and prebiotics decreases duration of acute diarrhea in children

Article Outline

• Question
• Design
• Setting
• Participants
• Intervention
• Outcomes
• Main Results
• Conclusion
• Commentary
• Copyright

Passariello A, Terrin G, De Marco G, Cecere G, Ruotolo S, Marino A, et al. Efficacy of a new hypotonic oral rehydration solution containing zinc and prebiotics in the treatment of childhood acute diarrhea: a randomized controlled trial. J Pediatr 2011;158:288-92.

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Question 

Among children with acute diarrhea, does a hypotonic oral rehydration solution (ORS) containing zinc and prebiotics result in more rapid resolution of symptoms compared with a standard ORS?

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Design 

Single-blind, prospective, controlled trial.

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Setting 

Outpatient primary care practices in Italy.

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Participants 

119 children (age range, 3-36 months) with acute diarrhea.

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Intervention 

Group 1 received standard hypotonic ORS and group 2 received a new hypotonic ORS containing zinc and prebiotics.

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Outcomes 

Rate of resolution of diarrhea at 72 hours.

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Main Results 

A total of 60 children in group 1 (34 male; mean age, 18.58 months; 95% CI, 15.5-21.6) and 59 in group 2 (36 male; mean age, 19.26 months; 95% CI, 15.9-22.6) completed the study protocol. The rate of diarrhea resolution at 72 hours was higher in group 2 (50% versus 72.9%, P = .010, Number Needed to Treat = 5). Total ORS intake in the first 24 hours was higher in group 2 (50 mL/kg; 95% CI, 41-59 versus 22 mL/kg; 95%CI, 17-29; P < .001). The mean number of missed working days by the parents of children in group 2 was lower (0.39; 95% CI, 0.08-0.70 versus 1.45; 95% CI, 1.02-1.88; P < .001). Fewer patients in group 2 needed adjunctive drugs for the treatment of diarrhea (6/59 versus 19/60, P = .004). No adverse events were observed in either of the two groups.

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Conclusion 

The addition of zinc and prebiotics to ORS limits diarrhea duration in children.

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Commentary 

This is an important and well-done, valid study that demonstrates the effectiveness of an ORS containing zinc and prebiotics in decreasing the duration of acute diarrhea in children. It has been previously documented that zinc enhances the absorption of water and electrolytes across the intestinal mucosa. Furthermore, prebiotics affect the intestinal microbiota composition and have been shown to prevent and treat diarrhea. Prior studies have mostly been done in developing countries, but this study shows the benefit for children in developed countries. Just 5 children would need to be treated to result in resolution of diarrhea at 72 hours for one patient. This seems to be a simple, safe, and effective intervention for children with acute diarrhea.