Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis.

<h4>Background</h4>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.<h4>Methods and findings...

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Autores principales:	Su-Ting T Li, David C Grossman, Peter Cummings
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2007
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/7e4311202a1546d0bb925634cb85db43
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spelling	oai:doaj.org-article:7e4311202a1546d0bb925634cb85db432021-12-02T19:55:58ZLoperamide therapy for acute diarrhea in children: systematic review and meta-analysis.1549-12771549-167610.1371/journal.pmed.0040098https://doaj.org/article/7e4311202a1546d0bb925634cb85db432007-03-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.0040098https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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 <or=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.Su-Ting T LiDavid C GrossmanPeter CummingsPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 4, Iss 3, p e98 (2007)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Su-Ting T Li David C Grossman Peter Cummings Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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 <or=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.
format	article
author	Su-Ting T Li David C Grossman Peter Cummings
author_facet	Su-Ting T Li David C Grossman Peter Cummings
author_sort	Su-Ting T Li
title	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_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_sort	loperamide therapy for acute diarrhea in children: systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2007
url	https://doaj.org/article/7e4311202a1546d0bb925634cb85db43
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Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis.

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