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Guidelines for managing acute gastroenteritis based on a systematic review of published research  
  1. M S Murphy
  1. Institute of Child Health, Clinical Research Building, Whittall Street, Birmingham B4 6NH, UK
  1. Dr Murphy.

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This paper is intended to provide evidence-based recommendations about the assessment and clinical management of infants and children with acute gastroenteritis. These guidelines were derived from a systematic review of published research. The diagnosis of gastroenteritis is not addressed; this is often presumptive and is based on a history of acute diarrhoea in the absence of other likely explanations. Microbiological investigation is not necessary in every case, but may be important in patients who require admission to hospital, in those who have bloody or mucoid diarrhoea suggesting colitis, in high risk patients such as those with an immune deficiency, and in cases where there is diagnostic uncertainty. Clinicians should apply general medical knowledge and clinical judgment in using these guidelines.

Scope of guidelines

The topics addressed are: assessment of the risk of dehydration; assessment of the degree of dehydration; oral rehydration therapy (ORT); strategies for rehydration and maintenance of hydration; management of hypernatraemic dehydration; nutritional management during and after the illness; and the role of pharmacological agents including antidiarrhoeals and antimicrobials.

Systematic review: search strategy and evaluation of the evidence

The search was performed using the medline and Cinahl databases, and covered the years 1966–97. Some relevant articles were also identified from the references cited in publications identified from these databases. The search was limited to studies of human subjects published in English. Subject headings employed were: “gastroenteritis”, “diarrhoea”, “rehydration solutions”, “dehydration”, and “hypernatraemia”. Textword searches were also done using the terms “infectious diarrh$”, “oral rehydration solution$”, and “hypernatr$ dehydration”. For each topic the terms “review”, “meta-analysis”, “randomised controlled trial”, “cohort study”, and “case control study” were applied. The Cochrane Library database of systematic reviews was searched under subject headings. Evidence from the medical literature and the strength of the recommendations given were then categorised according to a previously described scheme (table1).1

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Table 1

Categories of evidence and recommendations

Assessment of hydration

The risk …

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