LOW OSMOLAR ORS FOR TREATING DIARRHEA IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction:Dehydration is one of the main complications of diarrhea. Rationale: Standard WHO-ORS reduces dehydration, but does not reduce stool volume and duration of diarrhea. Low osmolar ORS produce maximal water absorption. Objectives: To evaluate the efficacy of low osmolar ORS in comparison to standard WHO-ORS. Materials and Methods: A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) comparing efficacy of low osmolar ORS and standard WHO-ORS in childhood diarrhea was carried out. RCTs were searched in PubMed, Cochrane CENTRAL, DOAJ, Google Scholar and Google. The data was extracted in Excel and entered in Review Manager 5.3 for calculation of effect sizes. Results: The outcome of stool output was reported in 9 trails. Reduced osmolarity ORS resulted in significantly reduced stool output as compared with standard WHO-ORS (pooled standardized mean difference -0.44, 95% CI -0.72 to -0.15). Information for the outcome of duration of diarrhea was available from 6 trials. The pooled standardized mean difference was -0.21 (95% CI -0.79 to 0.37), suggesting that reduced osmolarity ORS did not have significant effect on the duration of diarrhea as compared to standard WHO-ORS. The outcome of need for intravenous fluid therapy was reported in 8 trials. The meta-analysis revealed that reduced osmolarity ORS when compared to WHO standard ORS was associated with fewer unscheduled intravenous infusions (Odds Ratio 0.62, 95% CI 0.47 to 0.83). The meta-analysis for the outcome of vomiting reported in 5 clinical trials showed that children treated with low osmolar ORS were less likely to vomit than children treated with standard WHO-ORS (Odds Ratio 0.74, 95% CI 0.57 to 0.97). Conclusion: Low osmolar ORS when compared to standard WHO-ORS is associated with reduced stool output, reduction in need for unscheduled intravenous infusion and lesser episodes of vomiting. However, there was no significant difference in duration of diarrhea