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.