- A network meta-analysis finds that 2 combination interventions, Saccharomyces boulardii (SB)+zinc (ZN) and smectite (SM)+ZN, were the most effective of 27 pharmacological or nutritional interventions for reducing the duration of pediatric acute diarrhea and gastroenteritis (ADG) relative to placebo or standard intervention.
Why this matters
- There is a paucity of comparative effectiveness data, hindering physician selection of interventions.
- Network meta-analysis of 174 studies (n=32,430 children) that met eligibility criteria after a search of Medline, EMBASE, Global Health, CINAHL, LILACS, and CENTRAL.
- Comparative effectiveness was measured by summary under the cumulative curve (SUCRA) values with their credible intervals (Crl), with higher SUCRA values indicating greater effectiveness.
- Funding: None.
- The best interventions (vs placebo or standard) were:
- SB+ZN (SUCRA, 0.92; 95% CrI, 0.77-1.00) and
- SM+ZN (SUCRA, 0.88; 95% CrI, 0.35-1.00).
- The second-best interventions were:
- ZN (inpatients; SUCRA not available; mean difference [MD], −29.0; 95% CrI, −35.9 to −22.1),
- symbiotics (SUCRA, 0.77; 95% CrI, 0.38-0.92),
- ZN+lactose-free formula (SUCRA, 0.61; 95% CrI, 0.19-0.92),
- ZN (SUCRA, 0.50; 95% CrI, 0.27-0.69),
- loperamide (Imodium; SUCRA, 0.46; 95% CrI, 0.15-0.85, but had more adverse effects than placebo), and
- ZN+micronutrients (SUCRA, 0.46; 95% CrI, 0.15-0.85).
- No benefit: vitamin A, micronutrients, prebiotics, and kaolin-pectin.
- High heterogeneity across studies.