AAP endorses new
gastroenteritis treatment guidelines
New guidelines developed by the Centers for Disease Control and
Prevention (CDC) aim to help children worldwide who are affected
by acute gastroenteritis. Resulting in 1.5 million outpatient
visits in the United States, 200,000 hospitalizations, approximately
300 deaths, and costs of approximately $1 billion per year, gastroenteritis
is a major national problem. But it is not nearly as bad as in
developing countries, where an estimated two million children
under age 5 die from acute diarrhea each year. A worldwide campaign
by the World Health Organization to treat acute diarrhea with
oral rehydration therapy (ORT) is credited with reducing the death
toll from five million deaths in 1982 to two million deaths in
2003.
In the fall of 2003, Christopher
Duggan, MD, MPH, director of the Clinical Nutrition
Service at Children's Hospital Boston, worked with a panel of
specialists to update the 1992 CDC guidelines for gastroenteritis
management based on recent developments. The new guidelines were
adopted in August 2004 by the American Academy of Pediatrics (AAP).
ORT protocols designed for developing countries are now recommended
as the standard of care for children in the United States and
other industrialized countries, where intravenous therapy has
become the first line of treatment for acute diarrhea and dehydration.
The AAP's Managing
Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance,
and Nutritional Therapy states that the AAP "endorses
the Centers for Disease Control and Prevention updated recommendations
concerning diarrhea management in children. ORT, which includes
timely use of oral rehydration solutions (ORS) and early nutritional
support, has been proven to be safe and effective therapy for
almost all cases of acute diarrhea. Recent clinical trials have
also documented improved outcomes with an ORS of reduced concentrations
of sodium and glucose. Educating physicians and parents about
ORT is urged in order to avoid unnecessary clinic visits, hospitalizations
and in some cases, death."
It is hoped that the new CDC report and recommendations will
change the way pediatricians in the United States manage acute
diarrhea in children. They can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm.
