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Issuance of 2016 Clinical Practice Guidelines for Acute Infectious Diarrheal Disease of Children in China

2016-07-15

Introduction: On July 15, 2016, Group of Gastroenterology, Society of Pediatrics, Chinese Medical Association, editorial board of Chinese Journal of Pediatrics jointly formulated and officially released 2016 Clinical Practice Guidelines for Acute Infectious Diarrheal Disease of Children in China. Main content of the guidelines is summarized below:

Infectious diarrheal disease is a widespread infectious disease with high incidence rate around the world, which has serious damage to human, especially children. According to household investigation data of some provinces, the prevalence of diarrheal disease of the entire population in China is 0.17-0.70 times/man year, and it was 2.50-3.38 times/ man year in children less than 5 years old.

The diarrheal disease investigation result of our country has indicate that there are 2 peak season of diarrheal disease every year. One is June to August, with predominant pathogen of cathartic escherichia coli and shigella dysenteriae, and the other peak is October to December, with predominant pathogen of rotavirus.

Fluid replacement therapy [oral rehydration salts (ORS), intravenous infusion] is the major therapy for acute infectious diarrhea regardless of the causes for the prevention and treatment of disturbance of water and electrolyte, acid-base imbalance, dietary therapy and drug therapy.

For standardizing the diagnosis and treatment of diarrhea, Group of Digestology and Group of Infection, Society of Pediatrics, Chinese Medical Association, and editorial board of Chinese Journal of Pediatrics formulated “Expert consensus on the principle of diagnosis and treatment of diarrhea in children” in 2009 according to the guidelines for diarrhea management jointly issued by World Health Organization (WHO) and United Nations Children's Fund (UNICEF) in 2005. Identification of dehydrating signs, El ORS and continuous feeding in diarrhea management are emphasized, breast feeding is advocated, use of hypotonic ORS and zinc supplementation therapy is recommended. The promotion and implementation of “expert consensus” has played a positive role in the standardization of diarrhea treatment, early application of ORS for dehydration prevention and correction, reduction of intravenous infusion and antibiotics abuse. However, the efficacy, safety and economic indicators of above-mentioned therapies and drugs are what pediatric medical workers pay attention to.

For better helping clinicians manage children with acute infectious diarrhea properly, Group of Digestology, Society of Pediatrics, Chinese Medical Association, and editorial board of Chinese Journal of Pediatrics reorganized experts of pediatric digestive disease, infectious disease and epidemiology, and formed expert working group, formulated “Clinical Practice Guidelines for Acute Infectious Diarrheal Disease of Children in China” by analyzing domestic and foreign clinical data up to June 2013 according to the evidence-based medicine principle on the basis of original “expert consensus” and “Guidelines for clinical management of diarrhea” of WHO and UNICEF and diarrhea-related guidelines of America and Britain for providing reference for pediatricians in clinical practice. With respect to diagnosis, ORS, continuous feeding and zinc supplementation therapy which have been settled, original consensus and evidence of other guidelines are used in the clinical practice guidelines.

For some controversial therapies, such as the application of solution for dilatation for severe dehydration induced by acute diarrhea in children, lactose-free diet, antiviral drugs, antibiotics, nonspecific antidiarrheal drugs (microecologics, montmorillonite, racecadotril, etc.), clinical questions were raised, and preliminary recommendations were formed after evidence assessment by applying the evidence-based methods via respective document retrieval, evidence collection for the raised clinical questions, and then recommendations were formed after discussing and asking for the opinions of experts openly. 



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