Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis

BACKGROUND: Loperamide is widely used in adults for acute diarrhea. However, its use in children has been discouraged by the World Health Organization and the American Academy of Pediatrics owing to concerns over safety and efficacy in young children. METHODS AND FINDINGS: To assess the efficacy and...

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Autores principales: Li, Su-Ting T, Grossman, David C, Cummings, Peter
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831735/
https://www.ncbi.nlm.nih.gov/pubmed/17388664
http://dx.doi.org/10.1371/journal.pmed.0040098
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author Li, Su-Ting T
Grossman, David C
Cummings, Peter
author_facet Li, Su-Ting T
Grossman, David C
Cummings, Peter
author_sort Li, Su-Ting T
collection PubMed
description BACKGROUND: Loperamide is widely used in adults for acute diarrhea. However, its use in children has been discouraged by the World Health Organization and the American Academy of Pediatrics owing to concerns over safety and efficacy in young children. METHODS AND FINDINGS: To assess the efficacy and adverse effects of loperamide compared with placebo for acute diarrhea in children, we reviewed Medline, EMBase, the Cochrane Central Register of Controlled Trials, and bibliographies of known clinical trials and of review articles, and we also interviewed key investigators in the field. We undertook a systematic review and meta-analysis of randomized controlled trials of children younger than 12 y of age with acute diarrhea, comparing loperamide with placebo. Included trials reported data on diarrhea duration or severity, or provided data on adverse effects. Compared with patients who received placebo, patients allocated to loperamide were less likely to continue to have diarrhea at 24 h (prevalence ratio 0.66, 95% confidence interval [CI]: 0.57 to 0.78), had a shorter duration of diarrhea by 0.8 d (95% CI: 0.7 to 0.9 d), and had a lower count of stools at 24 h (0.84, 95% CI: 0.77 to 0.92). Results were similar when random-effects summaries were estimated. Serious adverse events, defined as ileus, lethargy, or death, were reported in eight out of 927 children allocated to loperamide (0.9%, 95% CI: 0.4% to 1.7%). Serious adverse events were not reported in any of the 764 children allocated to placebo (0%, 95% CI: 0% to 0.5%). Among the children allocated to loperamide, serious adverse events were reported only among children younger than 3 y. CONCLUSIONS: In children who are younger than 3 y, malnourished, moderately or severely dehydrated, systemically ill, or have bloody diarrhea, adverse events outweigh benefits even at doses ≤0.25 mg/kg/d. In children who are older than 3 y with no/minimal dehydration, loperamide may be a useful adjunct to oral rehydration and early refeeding.
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spelling pubmed-18317352007-03-24 Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis Li, Su-Ting T Grossman, David C Cummings, Peter PLoS Med Research Article BACKGROUND: Loperamide is widely used in adults for acute diarrhea. However, its use in children has been discouraged by the World Health Organization and the American Academy of Pediatrics owing to concerns over safety and efficacy in young children. METHODS AND FINDINGS: To assess the efficacy and adverse effects of loperamide compared with placebo for acute diarrhea in children, we reviewed Medline, EMBase, the Cochrane Central Register of Controlled Trials, and bibliographies of known clinical trials and of review articles, and we also interviewed key investigators in the field. We undertook a systematic review and meta-analysis of randomized controlled trials of children younger than 12 y of age with acute diarrhea, comparing loperamide with placebo. Included trials reported data on diarrhea duration or severity, or provided data on adverse effects. Compared with patients who received placebo, patients allocated to loperamide were less likely to continue to have diarrhea at 24 h (prevalence ratio 0.66, 95% confidence interval [CI]: 0.57 to 0.78), had a shorter duration of diarrhea by 0.8 d (95% CI: 0.7 to 0.9 d), and had a lower count of stools at 24 h (0.84, 95% CI: 0.77 to 0.92). Results were similar when random-effects summaries were estimated. Serious adverse events, defined as ileus, lethargy, or death, were reported in eight out of 927 children allocated to loperamide (0.9%, 95% CI: 0.4% to 1.7%). Serious adverse events were not reported in any of the 764 children allocated to placebo (0%, 95% CI: 0% to 0.5%). Among the children allocated to loperamide, serious adverse events were reported only among children younger than 3 y. CONCLUSIONS: In children who are younger than 3 y, malnourished, moderately or severely dehydrated, systemically ill, or have bloody diarrhea, adverse events outweigh benefits even at doses ≤0.25 mg/kg/d. In children who are older than 3 y with no/minimal dehydration, loperamide may be a useful adjunct to oral rehydration and early refeeding. Public Library of Science 2007-03 2007-03-27 /pmc/articles/PMC1831735/ /pubmed/17388664 http://dx.doi.org/10.1371/journal.pmed.0040098 Text en © 2007 Li et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Li, Su-Ting T
Grossman, David C
Cummings, Peter
Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title_full Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title_fullStr Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title_full_unstemmed Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title_short Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis
title_sort loperamide therapy for acute diarrhea in children: systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831735/
https://www.ncbi.nlm.nih.gov/pubmed/17388664
http://dx.doi.org/10.1371/journal.pmed.0040098
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