The Cochrane Library newsletter, Issue 3, 2006
Don't bother with intravenous rehydration for diarrhoea – oral rehydration works just as well
In wealthy countries it is fashionable to prefer intravenous therapy (IVT) over oral rehydration therapy (ORT). A Cochrane Review however, shows that ORT is just as effective as IVT.
The World Health Organization estimates that in low-income and middle-income countries about 1.8 million children below the age of five years die of diarrhoea each year. Almost 50% of these deaths are due to dehydration and most affect children less than one year of age. Children in high-income countries are not exempt. In the USA, for example, each year roughly 22 to 38 million episodes of diarrhoea occur among the 16.5 million children under the age of five years. Diarrhoea accounts for an estimated 2.1 to 3.7 million physician visits per year and 9% to 10% of all hospital admissions.
The issue is how best to provide these children with fluids and salts – IVT or ORT?
Despite the fact that the American Academy of Pediatrics and the Centers for Disease Control recommend ORT, pediatricians in North America tend to use IVT.
By studying the data from 18 trials, nine of which took place in high income countries, a group of Cochrane researchers found that for every 25 children treated with ORT, only one would need to move on to IVT. If the low osmolarity solution recommended by the WHO is used, then this drops to one in a hundred.
The Review Authors also point out that IVT is much more technically demanding, as the clinicians need to calculate flow rates, whereas with ORT the child's thirst mechanisms will help to regulate intake.
"It seems reasonable that children presenting for medical care with mild to moderate dehydration secondary to acute gastroenteritis should initially be treated with ORT. Should treatment fail, then IVT may be used," says senior Review Author, Dr William Craig who works at University of Alberta, in Edmonton, Canada
Review Title: Hartling L et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004390.
Acupuncture can help clear a chronic pain in the neck
There is moderate evidence that acupuncture can relieve chronic neck pain. Between 26 – 71 percent of the adult population claims to have had at least one episode of neck pain or stiffness during their life. In many cases, this can last for months and has a large impact on life style, work and health care expenditure.
Acupuncture is one of the complementary medicines that is frequently used. A group of Canadian-led Cochrane Review Authors completed a systematic review of the research literature to see whether there is evidence that it works.
They found 10 trials, with a total of 661 participants, which investigated whether acupuncture alleviated neck pain. In nine of the trials, participants had suffered neck pain for three or more months, while one included people who had had pain for at least six weeks.
To assess whether acupuncture reduces pain at all, some trials compared acupuncture with "sham" or "placebo" treatments. In other trials, the researchers were trying to see how well acupuncture worked compared to another treatment.
Overall, people who received acupuncture reported better pain relief immediately after treatment than those who received sham treatments such as TENS or laser that had the machines switched off, or acupuncture with the needles inserted in the wrong place. People who had acupuncture also reported that their pain went away to a greater extent than those who were just on a list waiting for treatment. In one small trial, people who received acupuncture reported better pain relief in the short-term than those who received massage therapy. There were no serious side effects reported in any of these trials.
"What we need now are some trials that include greater numbers of people and look at the long-term effect of the treatment," says lead Review Author Dr Kien Trinh who works in McMaster University, Hamilton, Canada.
Review Title: Trinh KV et al. Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004870.
Anti-histamines cannot be recommended as a general therapy for non-specific coughs in children
Children with a cough that lasts more than 3-4 weeks and is not associated with an identifiable illness are sometimes given anti-histamines. In adults with chronic cough, anti-histamines are recommended as an empirical treatment, but a systematic review of research failed to find evidence that it works for children. Anti-histamines do, however, have well known side-effects.
Balancing the small chance of benefit against the known risks, caused the researchers to conclude that; "antihistamines cannot be recommended as empirical therapy for children with chronic cough; very young children are particularly vulnerable to the adverse events."
There are two broad classes of anti-histamines – the first generation H1 receptor antagonists (eg. diphenhydramine, hydroxyzine, chlorpheniramine, brompheniramine and clemastine), and the second generation non sedating antihistamines (terfenadine, astemizole, loratadine and cetirizine). The first generation drugs are less specific in their action and tend to have more side-effects.
One study that the researchers looked at found that cetirizine did reduce coughing within 2 weeks of starting treatment.
"There is a surprising lack of high quality evidence in this area, given that millions of children around the world have chronic coughs each year," according to lead Review Author Associate Professor Anne Chang. "What we need are well designed randomised controlled trials of anti-histamines that are designed so that neither the child nor carers know which treatment is being given – this will help rule out any placebo effect that could confuse the results."
Review Title: Chang et al. Anti-histamines for prolonged non-specific cough in children. Cochrane Database of Systematic Reviews 2006, Issue 3. Art No: CD005604
Notes for editors:
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ª Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, et al. Methodology and reports of systematic Reviews and meta-analysies: a comparison of Cochrane Reviews with articles published in paper-based journal.
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