Page 135 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

8.2.1 Adsorbent agents

8.2.1.1 Kaolin

Evidence overview
A trial 166 conducted in the Gambia included children with diarrhoea aged between 3 and
18 months (n = 97). Those requiring antibiotic therapy or with positive diagnosis for malaria were
excluded. Participants were allocated to treatment with kaolin and ORS solution (n = 45) or to
administration of ORS solution alone (n = 52). The method of randomisation was inadequate (birth
order allocation) and allocation concealment and follow-up were not reported. Compliance with
the doses of kaolin was poor in 33% of the participants. The outcomes considered were duration
of diarrhoea and the number of stools per day in both groups. [EL = 1−]
No statistically significant differences were found between the kaolin and the ORS solution
groups in the mean duration of diarrhoeal episodes or in the mean number of stools per day.

Evidence summary
There was a lack of high-quality evidence for the effectiveness of kaolin in the treatment of acute
diarrhoea in children. A quasi-randomised controlled trial [EL = 1−] showed no differences in the
duration of acute diarrhoea or in the number of stools per day between children receiving kaolin
with rehydration therapy and children receiving rehydration therapy alone.

8.2.1.2 Activated charcoal

Evidence overview
One RCT was identified that included 39 children aged between 1½ months and 10 years
with acute gastroenteritis and severe dehydration (n = 39). 167 [EL = 1−] Children with acute
gastroenteritis due to Entamoeba histolytica were excluded. Participants were allocated to
treatment with activated charcoal with oral and IV rehydration solution (n = 16) or oral and IV
rehydration alone (n = 23). The method of randomisation, allocation concealment, follow-up and
baseline comparability of the two groups were poorly reported. The outcomes considered were
duration of diarrhoea and fluid therapy administered.
The study found that the group receiving the activated charcoal had a statistically significantly
shorter mean duration of diarrhoea (mean 2.12 days) than the control group (mean 3.00 days)
(WMD −0.88 days; 95% CI −1.50 to −0.26 days). Children in the activated charcoal group
required statistically significantly less ORS solution (mean 3.25 packs) than the control group
(mean 5.43 packs), (WMD −2.18 packs; 95% CI −3.84 to −0.52 packs). There was no statistically
significant difference in the mean IVT (Ringer’s lactate solution) required between groups.

Evidence summary

There was some evidence from a poorly reported RCT suggesting that the additional use of
activated charcoal in the treatment of children with gastroenteritis shortened the duration of
the diarrhoea and reduced the amount of ORT required when compared with the standard
rehydration therapy alone. On the other hand, the same trial showed no difference in the amount
of IV rehydration therapy required between the children receiving activated charcoal and the
children who did not received the adsorbent agent.

8.2.1.3 Smectite

Evidence overview
One relevant systematic review of trials comparing smectite with placebo or no treatment for
diarrhoea in children was identified. 168 This well-conducted systematic review included nine
RCTs published between 1986 and 2002. Two trials were conducted in France, one in Italy,
one in Lithuania, two in Thailand, one in Egypt and one in China. The nine studies included
data from 1238 participants: 622 received smectite and 616 received placebo or no additional
treatment. Even though it was reported that the doses of smectite were similar across the studies,

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