Meta-analysis: best interventions for acute diarrhea, gastroenteritis in kids

  • Florez ID & al.
  • PLoS One
  • 1 Jan 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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  • 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.

Study design

  • 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.

Key results

  • 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.

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