Polymer-based oral rehydration solution for treating acute watery diarrhoea
Editorial Group: Cochrane Infectious Diseases Group
Published Online: 14 APR 2009
Assessed as up-to-date: 10 NOV 2008
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Gregorio GV, Gonzales MLM, Dans LF, Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006519. DOI: 10.1002/14651858.CD006519.pub2.
- Publication Status: Unchanged
- Published Online: 14 APR 2009
Acute diarrhoea is one of the principal causes of morbidity and mortality among children in low-income countries. Glucose-based ORS helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization has recommended the osmolarity < 270 mOsm/L (ORS ≤ 270 ) over the > 310 mOsm/L formulation (ORS ≥ 310). Glucose polymer-based ORS (eg prepared using rice or wheat) slowly releases glucose and may be superior.
To compare polymer-based ORS with glucose-based ORS for treating acute watery diarrhoea.
In September 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and mRCT. We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.
Randomized controlled trials of people with acute watery diarrhoea (cholera and non-cholera associated) comparing polymer-based and glucose-based ORS (with identical electrolyte contents).
Data collection and analysis
Two authors independently assessed the search results and risk of bias, and extracted data. In multiple treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.
Thirty-four trials involving 4214 participants met the inclusion criteria: 27 in children, five in adults and two in both. Twelve trials used adequate methods to conceal allocation. Most compared polymer-based ORS with ORS ≥ 310. There were fewer unscheduled intravenous infusions in the polymer-based ORS group compared with glucose-based ORS (ORS ≥ 310 and ≤ 270 groups combined) (RR 0.75, 95% CI 0.59 to 0.95; 2235 participants, 19 trials). Adults positive for Vibrio cholerae had a shorter duration of diarrhoea with polymer-based ORS than with ORS ≤ 270 (MD -7.11 hours, SD -11.91 to -2.32; 228 participants, 4 trials). Wheat-based ORS resulted in lower total stool output in the first 24 hours compared with ORS ≤ 270 (MD -119.85 g/kg, SD -114.73 to -124.97; 129 participants, 2 trials). Adverse effects were similar for polymer-based ORS and glucose-based ORS.
Polymer-based ORS shows some advantages compared to ORS ≥ 310 for treating all-cause diarrhoea, and in diarrhoea caused by cholera. Comparisons favoured the polymer-based ORS over ORS ≤ 270, but the analysis was underpowered. If specialists consider a potential role for polymer-based ORS, further trials against the current standard (ORS ≤ 270) will be required.
Plain language summary
Polymer-based oral rehydration solution (ORS) ORS for acute diarrhoea
Acute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea.
Most ORS is in the form of a sugar–salt solution, but over the years people have tried adding a variety of compounds ('glucose polymers') such as whole rice, wheat, sorghum, and maize. The aim is to slowly release glucose into the gut and improve the absorption of the water and salt in the solution. This review updates and expands on a 1998 Cochrane Review of rice-based ORS, and assesses the available evidence on the use of polymer-based ORS (both rice and non-rice based) in comparison with the glucose-based ORS.
The original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310). Glucose-based ORS with a lower osmolarity was later introduced in attempts to improve efficacy, and is considered better at reducing the amount and duration of diarrhoea.
Thirty-four trials involving 4214 participants met the inclusion criteria: 27 in children; five in adults; and two in both. Most trials compared polymer-based ORS with a sugar–salt ORS with a particular strength (ORS ≥ 310), which is slightly more salty than the currently agreed best formula (≤ 270 mOsm/L). The trials' methodological quality was variable.
Fewer people in the polymer-based ORS group needed a drip to be rehydrated compared with those in the glucose-based ORS group. Adverse events were similar for polymer-based ORS and glucose-based ORS.
The authors conclude that polymer-based ORS show some advantages compared to glucose-based ORS for treating diarrhoea of any cause and in diarrhoea caused by cholera. Limited evidence favoured the polymer-based ORS over ORS ≤ 270.
Further trials should compare the efficiency of ORS ≤ 270 with a polymer-based ORS.
急性腹瀉是低收入國家的兒童主要的罹病和死亡原因之一。葡萄糖的口服補充液在急性腹瀉時可以有效補充水分，防止進一步的脫水。世界衛生組織自2004年以後已建議使用滲透壓小於270 mOsm/L(ORS&≤ 270)優於滲透壓大於310 mOsm/L的配方(ORS &≥ 310)。葡萄糖聚合物為基礎的口服補充液(如製備由米飯或小麥製成者)可以緩慢釋放葡萄糖，可能是較佳的。
我們搜尋了自2008年九月以後Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and mRCT等資料庫。我們也聯繫了研究者、研究組織、製藥公司和搜尋參考資料。
共有34個臨床試驗，有4214受試者符合納入標準：27個試驗是針對兒童，5個試驗是針對成人和2個試驗是包含成人以及小孩。 12個臨床試驗使用適當的方法做盲分配，試驗中多是以口服補充液ORS &≥ 310和聚合物比較。使用聚合物為基礎的口服補充液與葡萄糖的口服補充液(ORS &≥ 310 and &≤；包括270組，RR 0.75，95% CI 0.59 – 0.95; 2235名受試者; 19個臨床試驗)相比，較少需要臨時的靜脈營養。成人霍亂弧菌患者使用聚合物為基礎的口服補充液和ORS &≤ 270組相比，腹瀉持續時間較短。(MD −7.11 小時, SD −11.91 to −2.32； 228個受試者，4個臨床試驗)。小麥為基礎的口服補充液和ORS &≤270組相比，在24小時內排便量較少(MD −119.85g/kg, SD −114.73 to −124.97;129個受試者，2個臨床試驗)。聚合物為基礎的口服補充液和葡萄糖的口服補充液之副作用相似。
治療各種原因所引起的腹瀉(包括霍亂造成的)，使用聚合物為基礎的口服補充液較ORS &≥ 310有效。聚合物為基礎的口服補充液較ORS &≤ 270為佳，但證據仍不夠強。如果專家學者認為，以聚合物為基礎的口服補充液，有其一定的治療角色，未來應進一步設計臨床試驗比較目前的治療準則(ORS &≤270)和聚合物為基礎的口服補充液之差異。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
原文為Plain language summary,非總結。