Title summary Keyword record Title Abstract writer Keyword todos Text Publication form Source DOI accession Number Trial it is registered Number Cochrane coporação, grupo Cochrane topic
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Você está assistindo: O que fazer quando esta com diarreia


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Background

Acute diarrhoea is der leading reason of fatality for crianças under 5 years that age. Most deaths estão caused by too much fluid e electrolyte losses. Racecadotril is an anti‐secretory drug that has actually been used ao acute diarrhoea in crianças as one adjunct to oralmente rehydration therapy.

Objectives

To assess the efficacy e safety that racecadotril porque o treating acute diarrhoea in crianças under five years that age.

Search methods

We searched a Cochrane transmittable Diseases coporação, grupo Specialized Register; a Cochrane quartel general Register of controlled Trials (CENTRAL, published in ns Cochrane biblioteca Issue 3, march 2019); MEDLINE; Embase; LILACS; ClinicalTrials.gov; e the mundo Health Organization international Clinical Trials Registry platform (WHO ICTRP), as much as 4 march 2019, para clinical trials nevertheless of publication language or status.

Selection criteria

Randomized managed trials (RCTs) that compared racecadotril to placebo or no intervention in enhancement to standard treatment (oral rehydration therapy) in crianças under five with acute diarrhoea. A primary outcomes were fail of oral- rehydration, expression of diarrhoea, e number of stools. The secondary outcomes were stool output, size of the hospitais stay, e adverse events.

Data collection and analysis

Two análise authors independently assessed attempt eligibility, extracted a data and assessed risk of bias. Us presented dichotomous dia with threat ratios (RR) and continuous data with mean difference (MD) or standardization mean distinction (SMD). Where appropriate, we merged trials com meta‐analysis and used a random‐effects version if there ser estar significant heterogeneity (I² ≥ 50%). We assessed ns certainty of ns evidence making use of the grade approach.

Main results

Seven RCTs com a bruta of 1140 entrants met ns inclusion criteria. A trials to be carried out on children aged 3 months to 5 years, in outpatient e inpatient facilities em ~ France, Spain, Peru, India, Kenya, e Ecuador. The efficacy e safety that racecadotril were contrasted to placebo or no treatment. Racecadotril might reduce ns risk that rehydration failure (RR 0.41, 95% CI 0.13 to 1.23; 2 RCTs, 192 participants; low‐certainty evidence). Encontro on term of diarrhoea, variety of stools in the first 48 hours estão insufficient to reach naquela conclusion; stool output in the o primeiro dia 48 hours appears to be reduced in the two trials measure this, although the encontro is not combinable. Length of hospital stay was semelhante in dois studies measuring this, and overall there was enquanto evidence that racecadotril increased in its entirety rate of adverse occasions (RR 0.90, 95% CI 0.66 to 1.22; 5 RCTs, 688 participants; low‐certainty evidence). Many adverse occasions in a racecadotril group were gentle or moderate.

Authors"https://chichimary.com/o-que-fazer-quando-esta-com-diarreia/imager_2_7599_700.jpg conclusions

Racecadotril appears to be naquela safe drug yet has small benefit in boosting acute diarrhoea in crianças under five years of age. Current evidence go not assistance routine use of racecadotril in management of acute diarrhoea in crianças under five outside of a context that placebo regulated RCTs.


Racecadotril para tratamento de crianças alcançar menos de cinco estou vivendo de idade com diarreia aguda

Qual obtivermos o objetivo desta revisão?

O objetivo desta revisão da Cochrane obtivermos avaliar se ministérios racecadotril denominada eficaz no tratamento de crianças alcançar menos de ano anos abranger diarreia. Os autor da alteração da Cochrane identificaram e analisaram todos os ensaios relevantes porque o responder der esta pergunta, tendo incluído sete ensaios clínico nesta revisão.

Mensagens chave

O racecadotril pode cair o ameaça de desidratação. Algum é absolutamente se mudança ou não o consistência de dejeções diarreicas ou a duração da diarreia.

O que foi estudado nisso revisão?

A diarreia excluir uma do principais causas de cerimônia em crianças alcançar menos de cinco a idade de idade, especiais em nação de baixo rendimento. As children que têm diarreia presente habitualmente dejeções aquosas e frequentes, ministérios que pode causa raiz perdas excessivas de líquido e eletrólitos (desidratação). Recomenda‐se naquela reposição de fluídos porque o prevenir e tratar der desidratação causa pela diarreia. Ministérios racecadotril tem sido utilizado, além disso à reposição de fluídos, porque o o curar da diarreia em crianças, uma virado que reduz naquela secreção de água e eletrólitos pelo dispositivo digestivo. O fármaco deve melhorar os sintomas da diarreia (encurtar der duração da diarreia alternativa reduzir a frequência das dejeções), bem como cair o ameaça de falido da reidratação. Durante entanto, não é clara se emprego racecadotril denominações realmente eficaz em crianças abranger diarreia.

Quais ser estar os básico resultados?

Os autores da modificação procuraram os ensaios disponível e incluíram sete ensaios. Os ensaios, enquanto total, incluir 1140 crianças abranger idades compreendidas entrou os 3 mês e os 5 anos. As children que receber racecadotril passou a ser comparadas com um grupo de controlo (crianças que, bonito de racecadotril, leva um placebo (uma anatomia que simula emprego fármaco contudo que algum contém racecadotril) alternativamente nada). A analisado mostrou eu imploro seu perdão as crianças com diarreia o que receberam racecadotril, em comparação abranger placebo alternativa nenhum fármaco:

• emprego racecadotril pode cair o ameaça de falência da reidratação (evidência baixa);• denominada incerto se o racecadotril encurtado ou não a continuando da diarreia (evidência extremamente baixa);• excluir incerto se ministérios racecadotril influencia o consistência de dejeções (evidência muito baixa);• o racecadotril pode reduzir o peso das dejeções (evidência baixa);• emprego racecadotril pode fazer pouca alternativa nenhuma diferença na duração a partir de internamento hospitalar para paciente internados (evidência baixa);• ministérios racecadotril pode ir pouca alternativamente nenhuma diferença nas taxa de evento secundários (evidência baixa)

Quão atualizada está isso é revisão?

Os autor desta alteração pesquisaram aprender publicados até 4 de março de 2019.


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Implications for practice

Racecadotril appears to be a safe drug however has tiny benefit in enhancing acute diarrhoea in children under 5 years the age. Current evidence go not assistance routine use of racecadotril in management of acute diarrhoea in children under five exterior of a context the placebo‐controlled RCTs.

Implications porque o research

More RCTs with good study design, report quality, and larger sample size estão still necessary if this medicine is come be more investigated as an option. Additional trials may consider failure that rehydration as an outcome ao evaluating efficacy the racecadotril. Lock might also stratify participants based on different level of an illness severity using more direct approaches, together as a severity scoring system, and investigate the impact of an illness severity top top efficacy.


Racecadotril contrasted to placebo/no treatment ao acute diarrhoea in children

Patient or population: acute diarrhoea in children Setting: hospital and outpatients Intervention: racecadotril Comparison: placebo/no therapy

Outcomes

Anticipated absolute effects* (95% CI)

Relative result (95% CI)

Number of attendees (trials)

Certainty of the evidence (GRADE)

Comments

Risk com placebo/no treatment

Risk com racecadotril

Failure that rehydration

106 per 1000

44 per 1000 (14 to 131)

RR 0.41 (0.13 come 1.23)

192 (2 RCTs)

⊕⊕⊝⊝ LOWa,b

Due to threat of bias e imprecision

Racecadotril might reduce ns risk of failure of rehydration

Duration that diarrhoea

Not pooled: mean e median to be inconsistently reported

2 trials concluded that racecadotril could shorten expression of diarrhoea if 3 com lower all at once risk of prejudice reported enquanto difference between two groups on this outcome

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867

(5 RCTs)

⊕⊝⊝⊝ really LOWc,d

Due to hazard of bias e inconsistency

We ser estar uncertain whether or no racecadotril shortens duration of diarrhoea.

Ver mais: Regras Para O Que É Libero No Voleibol, Qual A Função Do Líbero No Voleibol

Number of stools: measure in the first 24 hours after development of racecadotril

4.8 stools/person

In the racecadrotril group, patient on average had 0.24 stools much less than the control group (95% CI ‐0.90 come 0.43)

258

(2 RCTs)

⊕⊝⊝⊝ very LOWe,f

Due to danger of bias and inconsistency

We estão uncertain even if it is racecadotril influences a number the stools

Stool output:

measured in the primeiro 48 hrs after introduction of racecadotril

The typical stool output was 331 g/kg

The typical stool output in ns racecadotril group was 25.35 g/kg lower (34.32 lower to 15.99 lower)

_

301

(2 RCTs)

⊕⊕⊝⊝ short g,h

Due to risk of bias and imprecision

Racecadotril may reduce stool output; it ser estar estimated using der standardised mean distinction of ‐0.65 (‐0.88 to ‐0.41)

Length of hospital stay for inpatients

Not pooled: median was reported. The median size of hospitais stay 3 mim in 1 trial and 5 days in another.

The median size of hospitais stay is semelhante compared come the ao controle group

224

(2 RCTs)

⊕⊕⊝⊝ LOWi

Due to imprecision

Racecadotril might make tiny or no difference to length of hospitais stay for inpatients

Adverse events:

number of all types of adverse events

184 per 1000

166 per 1000 (121 come 224)

RR 0.90 (0.66 come 1.22)

688 (5 RCTs)

⊕⊕⊝⊝

LOW j,k

Due to risk of bias and imprecision

Racecadotril might make little or durante difference to prices of adverse events


aDowngraded by 1 ao serious threat of bias: both trials have unclear allocation concealment; one study has > 20% loss to follow‐up. BDowngraded by 1 for serious imprecision: der wide 95% CI that includes appreciable advantage (RR cDowngraded by 1 para serous threat of bias: 1 trial has unclear technique of arbitrarily sequence generation; 3 trials have unclear allocation concealment; one trial has actually > 20% loss come follow‐up; 2 trials have no decorrer blinding. DDowngraded through 2 porque o very serous inconsistency: inconsistent conclusions on the effect of the intervention (2 trials concluded the racecadotril could shorten expression of diarrhoea when 3 with lower overall risk of bias reported no difference between 2 teams on this outcome). EThe certainty the evidence foi ~ graded based upon 4 researches reporting this outcome. Downgraded by 1 ao serious risk of bias: 3 trials have actually unclear assignment concealment; 2 trials have no decorrer blinding; 2 trials have > 20% loss to follow‐up. FDowngraded by 2 para very serous inconsistency: inconsistent conclusions on ns effect of ns intervention (3 trials reported enquanto statistically difference in between 2 teams in number of stools in ~ 48 hours while one trial report racecadotril could be effective ao this outcome). GDowngraded by 1 for serious threat of bias: both trials have actually unclear an approach of arbitrarily sequence generation e unclear allocation concealment; 1 trial has actually > 20% loss to follow‐up. HDowngraded by 1 for serious imprecision; the bruta sample size era small (less than 400). IDowngraded by 2 ao serious imprecision; the venenoso sample size era small (less than 400) and no variance is given. JDowngraded by 1 ao serious risk of bias: 2 trials have actually unclear an approach of random sequence generation; 4 trials have unclear assignment concealment; 1 trial has no blinding; 3 trials have actually > 20% loss to follow‐up. KDowngraded by 1 for serious imprecision: a wide 95% CI that consists of appreciable benefit (RR

objectives


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aMean (standard deviation). bMedian (interquartile range). CMedian there is no reporting interquartile range.