META ANALYSIS: SMECTITE IN THE TREATMENT OF ACUTE INFECTIOUS DIARRHOEA IN CHILDREN

Abstract

Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrheal in many countries. To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhea in children. Using medical subject headings and free language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhea and smectite: medline, embase, cinahl and the cochrane library; additional references were obtained from reviewed articles. Only randomized controlled trials were included. Nine randomized controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized controlled trials showed that smectite significantly reduced the duration of diarrhea compared with placebo. The pooled weighted mean difference was (22,7 h, 95% CI: 24,8 to 20,6) with a fixed model and remained significant in a random effect model (24,4 h, 95% CI: 29,8 to 19,1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1,64, 95% CI: 1,36–1,98; number needed to treat 4,95% CI: 3–5). Adverse effects were similar in both groups. Smectite may be a useful adjunct to rehydration therapy in treating acute pediatric gastroenteritis. However, the results of this meta analysis should be interpreted with caution as most of the included studies had important limitations. Cost effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended.Key words: dioctahedral smectite, meta_analysis, acute infectious diarrhea, children.