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."
This press release is based on the following article:
Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials
Steven Bellemare, Lisa Hartling, Natasha Wiebe, Kelly Russel, William R Craig, Don McConnell, Terry P Klassen
To be published in BMC Medicine on 15 April 2004.
Upon publication this article will be available free of charge according to BMC Medicine's Open access policy via: http://www.biomedcentral.com/bmcmed
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For further information about this research, please contact Terry P Klassen, by email at terry.klassen@ualberta.ca or by phone on 780-407-7084
Alternatively, or for more information about BMC Medicine or Open Access publishing contact Gemma Bradley by phone on 44-207-323-0323 or by email at press@biomedcentral.com
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