Page 148 - 15Diarrhoeaandvomiting

Other therapies

in the study were divided into two groups according to their hospital file number on admission,
and thus allocation concealment was inadequate. The trial assessed the effect of administering
0.3 g/kg per day of glutamine in the treatment of acute diarrhoea in children. Mothers administered
the supplement (glutamine or placebo) in three daily doses for 7 days. The authors reported that
patients (and carers) and assessors were blinded to the treatment received and the sample size
was calculated based on a preliminary study that looked at duration of diarrhoea in 15 subjects.
The outcome considered was duration of the diarrhoeal episode. [EL = 1−]

Loss to follow-up was nearly 20%. The comparability between the two groups at the start
of the trial was adequate. The mean duration of diarrhoea in the group receiving glutamine
(n = 63, mean 3.40 days, SD 1.96 days) was shorter than in the control group (n = 65, mean
4.57 days, SD 2.48 days). This finding was statistically significant (WMD −1.17 days; 95% CI
−1.94 to −0.40 days). Data relating to duration of diarrhoea after treatment were stratified
by stool frequency on admission. Children in the glutamine group with a stool frequency
below eight per day (n = 46) had a mean duration of diarrhoea of 3.30 days (SD 1.96 days)
compared with 4.68 days (SD 2.60 days) in those receiving the placebo (n = 41). This finding
was statistically significant (WMD −1.38 days; 95% CI −2.36 to −0.40 days). When the data
collected from the children with high stool frequency, eight or more stools per day, were
analysed, no statistically significant difference in mean duration of diarrhoea was observed
between the groups. No statistically significant differences in the proportion with persistent
diarrhoea or vomiting were found.

Evidence summary
There was a lack of high-quality evidence for the effectiveness of glutamine supplementation
in the treatment of acute diarrhoea in children. A quasi-randomised controlled trial conducted
in Turkey [EL = 1−] showed no difference in the onset of persistent diarrhoea or vomiting. On
the other hand, the study suggested that glutamine supplementation shortens the duration of
diarrhoea by 1 day.

8.3.4 Folic acid

Evidence overview

A single study located in Bangladesh was identified as relevant and included in the review. 179
This RCT recruited 106 male children aged between 6 and 23 months who presented with watery
diarrhoea (of less than 72 hours’ duration) and some degree of dehydration. They were enrolled
after admission into the study ward. The participants were randomised into two treatment arms:
those receiving 5 mg folate (n = 54) and those receiving placebo (n = 52) every 8 hours for 5 days.
The method of randomisation and allocation concealment were not reported by the authors.
Subjects and investigators were blinded to the treatment administered. A power calculation was
performed. The outcomes measured were course of illness, stool output, ORS solution intake and
IV fluids received. [EL = 1+]
Baseline comparability between the two groups was adequate but loss to follow-up was not
reported. No statistically significant differences were observed between the two groups for the
mean duration of diarrhoea, the proportion having diarrhoea beyond 5 days, the mean total stool
output, the mean total intake of ORS solution or the proportion of all children receiving IVT.
Data were also analysed for rotavirus-positive children (n = 63) and the results did not show any
statistically significant differences in the intake, output or duration of diarrhoea between the folic
acid group (n = 34) and the placebo group (n = 29).

Evidence summary
Evidence from an RCT [EL = 1+] located in Bangladesh suggested that 5 days of folate
supplementation for the treatment of children with acute diarrhoea did not reduce the duration
of diarrhoea, the stool output, the ORS solution intake or the number of children requiring IVT.

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