Smectite for acute infectious diarrhoea in children

Giordano Perez-Gaxiola 1, Carlos A Cuello-García 2, Ivan D Florez3, Víctor M Pérez-Pico4

1 Hospital Pediátrico de Sinaloa, Evidence-Based Medicine Department, Culiacán, Sinaloa, Mexico
2 McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
3 University of Antioquia, Department of Pediatrics, Medellin, Antioquia, Colombia
4 Hospital Pediátrico de Sinaloa, Culiacán, Sinaloa, Mexico

Pérez-Gaxiola G, Cuello-García CA, Florez ID, Pérez-Pico VM. Smectite for acute infectious diarrhoea in children. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD011526. DOI: 10.1002/14651858.CD011526.pub2

 Access the full text article here: DOI: 10.1002/14651858.CD011526.pub2

What is the aim of this review?

The aim of this Cochrane Review was to find out if smectite (or diosmectite), a medicinal clay commonly prescribed to people who have diarrhoea in order to reduce their stool output, helps children with acute diarrhoea. We collected and analysed all relevant studies to answer this question and found 18 relevant studies.

Key messages

Giving smectite to children with acute diarrhoea may reduce its duration. However, more high-quality studies are still needed, including studies that assess different causes of diarrhoea and the economic effects of this treatment.

What was studied in the review?

Acute diarrhoea is one of the most common diseases in children. It is usually caused by a viral infection. The main aim of treatment is to maintain a good level of hydration. This is achieved with oral rehydration solutions, and few children need to be hospitalized or require intravenous rehydration. Still, even with proper hydration, having loose stools is a burden for both parents and patients.

Smectite may help by reducing inflammation in the gut; by acting as a barrier to reduce the penetration of toxins; or by increasing water absorption.

What are the main results?

We found 18 relevant studies with 2616 children that were conducted in both high-income and low- or middle-income countries. These studies compared children receiving smectite with children receiving routine care or a placebo (a pill or liquid that contains no medicine). Eight studies were funded by the manufacturer.

Smectite may reduce the duration of diarrhoea by one day (low-certainty evidence); may increase the number of children cured by day 3 (low-certainty evidence); and may slightly reduce the quantity of loose stools (low-certainty evidence).

We are uncertain whether smectite has an effect on how many stools children have (very low-certainty evidence). It may not have an effect on how many children need to be hospitalized (low-certainty evidence), and probably does not have an effect on how many children need intravenous rehydration (moderate-certainty evidence).

We found no reports of serious adverse effects. Minor adverse effects included constipation, vomiting, and bad taste, but these did not differ between groups.

How up-to-date is this review?

We searched for studies published up to 27 June 2017.