Diarrhoea in adults (acute).

INTRODUCTION: An estimated 4000 million cases of diarrhoea occurred worldwide in 1996, resulting in 2.5 million deaths. METHODS AND OUTCOMES:We conducted a systematic review and aimed to answer the following clinical questions:What are the effects of treatments for acute diarrhoea in adults living in resource-rich countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries traveling to resource-poor countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults living in resource-poor countries? What are the effects of treatments for acute severe diarrhoea in adults living in resource-poor countries? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS:We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria.We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, antimotility agents, antisecretory agents, bismuth subsalicylate, diet, intravenous rehydration, nasogastric tube rehydration, and oral rehydration solutions (amino acid oral rehydration solution, bicarbonate oral rehydration solution, reduced osmolarity oral rehydration solution, rice-based oral rehydration solution, standard oral rehydration solution). symptom control (number of loose stools a day; stool volume; relief of cramps, nausea and vomiting; incidence of vomiting; incidence of severe illness); microbiological efficacy (eradication of pathogens); presence of bacterial resistance; and rate of hospital admission. compared racecadotril (200 mg loading dose repeated at 12 hours, then 300 mg/day until well) versus loperamide (2 times 1.33 mg loading dose repeated at 12 hours, then 3 times 1.33 mg until well). [17] The RCT found no significant difference between racecadotril compared with loperamide in duration of diarrhoea (2.2 days with racecadotril v 2.3 days with loperamide; reported as not significant). [17] The second RCT (62 people with acute diarrhoea) found no significant difference between racecadotril (100 mg 3 times daily) and loperamide (2.0 mg twice daily) in mean duration of diarrhoea (19.5 hours with racecadotril v 13 hours with loperamide; P = 0.23). [18] The third RCT (157 people with acute diarrhoea) found no difference between racecadotril (100 mg loading dose and 100 mg 3 times daily before to meals) compared with loperamide (4 mg loading dose and 2 mg after each loose stool) in the number of diarrhoeal stools until recovery (mean: 3.5 with racecadotril v 2.9 with loperamide; P value v P v 49 hours with placebo; adults: 43 hours with chlorpromazine v 44 hours with placebo; P values not reported), fluid requirements (children: 93.4 mL/kg with chlorpromazine v 104.3 mL/kg with placebo; adults: 100.2 mL/kg with chlorpromazine v 102.2 mL/kg with placebo; P values not reported) or volume loss (children: 250 mL/kg with chlorpromazine v 266 mL/kg with placebo; adults: 159 mL/kg with chlorpromazine v 189 mL/kg with placebo; P values not reported) in people with cholera. Results not reported for people in the non-cholera group. [68] The second RCT (46 adult males with severe dehydration caused by cholera) compared four doses of chlorpromazine (1 or 4 mg/kg as a single dose, given by mouth or injection) versus no treatment. [69] The RCT found that the duration of diarrhoea was significantly reduced among chlorpromazine treated people compared with no treatment (92.1 hours with im chlorpromazine 1 mg/kg v 99.0 hours with oral chlorpromazine 1 mg/kg v 94.6 hours with im chlorpromazine 4 mg/kg v 97.1 hours with oral chlorpromazine 4 mg/kg v 135.6 hours with no treatment; P values nor reported). [69]