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Other therapies

The GDG was aware that a recent Cochrane review had concluded that zinc supplementation
could be effective in the treatment of diarrhoea and vomiting in children with gastroenteritis in
areas where diarrhoea was an important cause of child mortality. The studies judged relevant
to this guideline demonstrated some benefit from zinc in reducing stool frequency but not the
mean duration of diarrhoea. There was some evidence that zinc treatment is associated with
increased vomiting. The GDG therefore concluded that there was insufficient evidence to justify
recommending zinc supplementation for well-nourished children with gastroenteritis.

There was no research evidence that vitamin A administration had a beneficial effect in children
with gastroenteritis (with the possible exception of those with shigella), despite the fact that most
of the trials took place in settings where malnutrition might be expected. There was little evidence
to support a beneficial effect from glutamine supplementation in the treatment of gastroenteritis.
There was no evidence to support the use of folic acid therapy, with no benefit being seen in a
study carried out in a population that might have been at risk of malnutrition. Although there was
some evidence suggesting possible benefit from the use of fibre-supplemented milk formulas in
reducing the duration of diarrhoea, the trials were not of high quality.

8.4 Alternative and complementary therapies

Evidence regarding the possible value of alternative or complementary therapies in the treatment
of gastroenteritis was sought. Only two studies of homeopathy remedies were identified and
examined.

Evidence overview

A systematic review and an RCT were identified that examined the effects of homeopathy
compared with placebo for the treatment of acute diarrhoea in children.

The systematic review 192 examined the effectiveness of individualised homeopathy therapy (with
one of 19 possible prescriptions) compared with placebo for the treatment of acute diarrhoea
in children. [EL = 1−] The results of three RCTs were included and meta-analysed in the review.
The trials had been conducted by the review’s first author in Nicaragua (two RCTs: pilot study
(n = 33) and main study (n = 81)) and Nepal (one RCT: n = 116) applying similar methodology
and design.
The review included results from 247 children aged 6 months to 5 years with a history of diarrhoea
(defined as three or more unformed stools per day) for no more than 7 days (Nicaragua) or 5 days
(Nepal). Children were excluded if they had received antidiarrhoeal treatment within 24–48 hours
prior to enrolment or if they had severe diarrhoea requiring hospitalisation or IV hydration.
Children were assessed on enrolment for baseline characteristics, given ORT as necessary
according to WHO recommendations and then interviewed by a homeopathic practitioner who
used a computer program to prescribe the appropriate homeopathic treatment from a choice
of 19 possible remedies. These had been prepared previously in the USA by a homeopathic
pharmacist to a liquid homeopathic dilution in the 30C potency. Randomisation was performed
by sequential assignment of children to pre-randomised and coded tubes of either placebo or
homeopathic therapy. Parents were instructed to give their child 1 tablet from the prescribed tube
after each unformed stool, to be dissolved in the mouth. Follow-up was performed by parents and
auxiliary nurses for 5 days (for 6 days in the pilot Nicaraguan trial) after the initial visit. All study
staff and the patients were blind to treatment allocation. The primary outcome measures were
duration of diarrhoea (defined as the number of days until there were two consecutive days with
less than three unformed stools per day) and mean number of stools per day.
When data were pooled, children were similar at baseline for sex and diarrhoeal outcomes
prior to study enrolment. However, children in the placebo group were significantly younger,
shorter and lighter than those receiving homeopathy treatments. This reflected a discrepancy in
randomisation in the Nepali study, as groups were essentially similar at baseline in the Nicaraguan
studies. This bias would tend to overestimate any difference in treatment effect seen between the
two groups.

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