Universal recommendations for the management of acute diarrhea in nonmalnourished children
Open accessAbstract
Objective: Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries. The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide. Methods: The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3‐step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer‐review and validation of recommendations. Results: A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%–96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%–95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended. Conclusions: Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners’ compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care‐associated costs.
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Our findings do not support recommendations for the use of specific probiotics for acute infectious diarrhoea in children.
“Our findings do not support recommendations for the use of specific probiotics for acute infectious diarrhoea in children (Floch 2015; Guarino 2018; Sniffen 2018).”
From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Guarino 2018
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Probiotics for treating acute infectious diarrhoea
Collinson, S., Deans, A., Padua-Zamora, A., Gregorio, G. V., Li, C., Dans, L. F., & Allen, S. J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003048.pub4 · Cited by 153 · see citing works
Use of Probiotics for the Management of Acute Gastroenteritis in Children: An Update
Szajewska, H., Guarino, A., Hojsak, I., Indrio, F., Kolacek, S., Orel, R., Salvatore, S., Shamir, R., van Goudoever, J. B., Vandenplas, Y., et al. (2020) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002751 · Cited by 90 · see citing works
Self-citationMourey, F., Sureja, V., Kheni, D., Shah, P., Parikh, D., Upadhyay, U., Satia, M., Shah, D., Troise, C., & Decherf, A. (2020) · Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000002849 · Cited by 33 · see citing works
Zhou, S., Yu, Y., Tian, J., Wang, X., Zeng, M., & Song, H. (2026) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1704508 · Cited by 2 · see citing works
- Authors
- Guarino, A., Lo Vecchio, A., Dias, J. A., Berkley, J. A., Boey, C., Bruzzese, D., Cohen, M. B., Cruchet, S., Liguoro, I., Salazar‐Lindo, E., Sandhu, B., Sherman, P. M., & Shimizu, T.
- Affiliations
- Federico II University Hospital (IT)
- Department of Translational Medical Sciences Section of Pediatrics University of Naples Federico II Naples Italy
- Hospital de São João (PT)
- Kenya Medical Research Institute (KE)
- Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Naples Federico II (IT)
- University of Alabama at Birmingham (US)
- University of Chile (CL)
- University of Udine (IT)
- Universidad Peruana Cayetano Heredia (PE)
- Bristol Royal Hospital for Children (GB)
- University of Toronto (CA)
- Juntendo University (JP)
- Corresponding author
- Guarino, Alfredo
- Liguoro, Ilaria
- ORCID
- Venue
- Journal of Pediatric Gastroenterology and Nutrition
- Publisher
- Wiley
- Published
- 2018-11
- Volume
- 67
- Issue
- 5
- Pages
- 586-593
- ISSN
- 0277-2116 (ISSN-L)
- 1536-4801
- PMC
- PMC7116696
- OpenAlex
- W2808211215
- Cited by
- 108
- References
- 0
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 6 · 2023: 28 · 2022: 17 · 2021: 6 · 2020: 20 · 2019: 8 · 2018: 5
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- Funders
- Office of Naval Research
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- acute gastroenteritis, acute diarrhea, children, oral rehydration therapy, probiotics, antidiarrheal agents, antiemetics, dietary management, guideline development
- MeSH terms
- Acute Disease, Adolescent, Child, Child, Preschool, Clinical Protocols, Diarrhea, Female, Gastroenteritis, Gastroenterology, Humans, Infant, Infant, Newborn, Male, Pediatrics, Societies, Medical, Practice Guidelines as Topic
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