Further studies comparing rehydration therapies would waste resources, say researchers

No further studies should be carried out to compare the effectiveness of oral rehydration and intravenous therapy for treating children who are dehydrated after suffering from diarrhoea, write researchers in BMC Medicine this week. Their systematic review of published research concludes that current guidelines recommending oral rehydration therapy as a first course of treatment are correct.

The researchers, from University of Alberta and Stollery Children’s Hospital, studied 14 randomised controlled trials that compared the safety and efficacy of the two rehydration therapies. They found that there were no significant differences in the failure rates of the two methods, and determined that this conclusion was unlikely to change substantially with further trials.

The researchers write: “This meta-analysis clearly demonstrates that further randomised controlled trials for children with dehydration secondary to diarrhoea are not warranted, or indeed, may be unethical to perform.”

Although there are circumstances when administering oral rehydration therapy is not appropriate, the WHO recommends that in most cases this treatment should be the first choice of physicians.

“Oral rehydration therapy is less traumatic to the child, simple to administer, and can be administered by parents in a variety of settings including the home,” write the researchers. They add: “Oral rehydration therapy is less expensive than intravenous therapy, and is associated with lower hospital admission rates and shorter lengths of stay.”

Terry Klassen, the research team leader said: “If we can convince paediatricians, family physicians, nurses and families to accept this evidence, then many fewer children will require the painful insertion of an intravenous catheter. It is sometimes tough to convince parents that frequent small amounts of fluids by mouth work as well as a needle in the vein and a bag of intravenous fluids. However, the research is clear, oral rehydration is much preferred and in the one or two percent who fail to respond, we can always start intravenous rehydration at that time.”

Despite the current guidelines, oral rehydration therapy is still being underused, especially by physicians in high-income countries. Increasing its usage worldwide could prevent 15% of deaths of children under five years of age.

The researchers argue that, “future research efforts in this area should focus on methods to improve the uptake of this effective and efficient intervention in both low- and high-income countries so that children around the world can benefit from ORT.”