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Diarrhoea and Vomiting in Children Under 5: Full Guideline

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Diarrhoea and Vomiting in Children Under 5: Full Guideline DRAFT FOR CONSULTATION 1 Diarrhoea and vomiting 2 3 4 5 6 National Collaborating Centre for Women’s 7 and Children’s Health 8 9 Commissioned by the National Institute for 10 Health and Clinical Excellence 11 12 13 14 15 16 Draft for consultation 17 October 2008 18 19 20 21 RCOG Press 22 Diarrhoea and vomiting: full guideline DRAFT October 2008 page 1 of 193 DRAFT FOR CONSULTATION 1 Contents 2 3 Guideline Development Group membership and acknowledgements 4 4 Guideline Development Group 4 5 Acknowledgements 4 6 Stakeholder organisations 5 7 Abbreviations 7 8 Glossary of terms 8 9 1 Scope and methodology 26 10 1.1 Introduction 26 11 1.2 Aim of the guideline 28 12 1.3 Areas within the scope of the guideline 28 13 1.4 Areas outside the scope of the guideline 29 14 1.5 For whom is the guideline intended 29 15 1.6 Who has developed the guideline? 29 16 1.7 Guideline development methodology 30 17 1.8 Schedule for updating the guideline 33 18 2 Summary of recommendations 34 19 2.1 Key priorities for implementation (key recommendations) 34 20 2.2 Summary of recommendations 36 21 2.3 Key priorities for research 42 22 2.4 Summary of research recommendations 43 23 2.5 Flow pathway for fluid management 43 24 3 Diagnosis 45 25 3.1 Clinical diagnosis 45 26 3.2 Laboratory investigations in diagnosis 51 27 4 Assessment for dehydration and shock 62 28 4.1 Clinical assessment 62 29 4.2 Laboratory investigations in assessment of dehydration 73 30 5 Fluid management 80 31 5.1 Primary prevention of dehydration 80 32 5.2 Treatment of dehydration 81 33 5.3 Oral fluids – optimal composition and administration 85 34 5.4 Intravenous fluid therapy (IVT) 92 35 5.5 Preventing recurrence of dehydration 99 36 6 Nutritional management 101 37 6.1 Feeding during rehydration 101 38 6.2 Feeding following rehydration 103 39 7 Antibiotic therapy 114 40 7.1 Introduction 114 41 7.2 Salmonella 114 42 7.3 Campylobacter 117 43 7.4 Yersinia 118 44 7.5 Shigella 119 45 7.6 Escherichia coli 119 46 7.7 Cryptosporidium 120 47 7.8 Treatment without prior identification of a pathogen 120 48 7.9 Traveller’s diarrhoea 123 49 7.10 Groups for whom antibiotic treatment may be indicated 124 Diarrhoea and vomiting: full guideline DRAFT October 2008 page 2 of 193 DRAFT FOR CONSULTATION 1 2 8 Other therapies 128 3 8.1 Anti-emetics 128 4 8.2 Antidiarrhoeal agents 133 5 8.3 Micronutrients and fibre 143 6 8.4 Probiotics 154 7 9 Escalation of care 164 8 10 Information and advice for parents and carers 167 9 10.1 Introduction 167 10 10.2 Caring for a child with diarrhoea and vomiting at home 167 11 10.3 Prevention of primary spread of diarrhoea and vomiting 168 12 Appendix A Cost effectiveness of IVT v ORT for children with dehydration 169 13 Appendix B Health economics of ondansetron 183 14 Appendix C Evidence tables see separate file 15 16 17 Diarrhoea and vomiting: full guideline DRAFT October 2008 page 3 of 193 DRAFT FOR CONSULTATION 1 Guideline Development Group 2 membership and acknowledgements 3 Guideline Development Group 4 GDG members 5 Stephen Murphy GDG Chair, Consultant Paediatric Gastroenterologist 6 Ed Abrahamson Consultant in Paediatric Emergency Medicine 7 Richard Churchill Associate Professor of Primary Care 8 Dianne Cook Children’s Community Specialist Practitioner 9 John Crimmins General Practitioner 10 Saul Faust Senior Lecturer in Paediatric Infectious Diseases/ Immunology 11 Alastair Hay General Practitioner 12 Naryndar Johal Parent/carer representative 13 Julie Marriott Parent/carer representative 14 Nigel Meadows Consultant Paediatric Gastroenterologist 15 Simon Minford Advanced Paediatric Nurse Practitioner 16 Robert Moy Senior Lecturer in Community Child Health 17 Enid Povey National Clinical Development Manager 18 Gyanranjan Prasad Sinha Consultant Paediatrician 19 Jenny Taylor Paediatric Nurse Practitioner 20 National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) staff 21 Monica Lakhanpaul Clinical Co-Director 22 Rajesh Khanna Senior Research Fellow 23 Shona Burman-Roy Research Fellow 24 Ana Palanca Research Fellow 25 Angela Kraut Research Fellow 26 Sjokvist Garcia-Stewart Research Fellow 27 Paul Jacklin Senior Health Economist 28 Itrat Iqbal Health Economist 29 Danielle Worster Information Scientist 30 Rosie Crossley Work Programme Coordinator 31 External advisers 32 George B Haycock Professor Paediatric Nephrology 33 Craig Williams Consultant Microbiologist, Glasgow 34 Martin Richardson Consultant Paediatrician, Peterborough 35 Peer reviewers 36 Olivier Fontaine Medical Officer, Child and Adolescent Health and Development, WHO 37 Gill Brookes 38 Kathleen Berry 39 Acknowledgements 40 Additional support was received from: 41 • Anna Bancsi, Martin Dougherty, Rupert Franklin, Eva Gautam-Aitken and Chris Kitchen at the NCC-WCH 42 • Caroline Keir at the National Institute for Health and Clinical Excellence (NICE) Diarrhoea and vomiting: full guideline DRAFT October 2008 page 4 of 193 DRAFT FOR CONSULTATION 1 • The Patient and Public Involvement Programme (PPIP) for NICE 2 Stakeholder organisations 3 Abbott Laboratories Limited 4 Association for Continence Advice 5 Association of Medical Microbiologists 6 Association of Psychoanalytic Psychotherapy in the NHS 7 Association of the British Pharmaceuticals Industry (ABPI) 8 Barnsley Hospital NHS Foundation Trust 9 Barnsley PCT 10 Bedfordshire PCT 11 Berkshire Healthcare NHS Trust 12 Boehringer Ingelheim Ltd 13 Bolton Council 14 Bournemouth and Poole PCT 15 Bradford & Airedale PCT 16 Breastfeeding Network, The 17 British Dietetic Association 18 British Homeopathic Association 19 British National Formulary (BNF) 20 British Society of Paediatric Gastroenterology, Hepatology & Nutrition (BSPGHAN) 21 Buckinghamshire PCT 22 Calderdale PCT 23 Cardiff and Vale NHS Trust 24 Chelsea & Westminster Acute Trust 25 CIS’ters 26 College of Emergency Medicine 27 Commission for Social Care Inspection 28 Company 29 Connecting for Health 30 ConvaTec 31 Cornwall & Isles of Scilly PCT 32 Department for Communities and Local Government 33 Department of Health 34 Department of Health, Social Security and Public Safety of Northern Ireland 35 Derbyshire Mental Health Services NHS Trust 36 General Chiropractic Council 37 General Osteopathic Council 38 GlaxoSmithKline UK 39 Good Hope Hospitals NHS Trust 40 Greater Manchester West Mental Health NHS Foundation Trust 41 Harrogate and District NHS Foundation Trust 42 Health and Safety Executive 43 Health Protection Agency 44 Healthcare Commission 45 Home Office 46 Infection Prevention Society 47 Institute of biomedical Science 48 La Leche League GB 49 Leeds PCT 50 Liverpool PCT 51 Luton and Dunstable Hospital NHS Trust 52 Meat & Livestock Commission 53 Medicines and Healthcare Products Regulatory Agency (MHRA) 54 Medicines for Children Research Network (MCRN) 55 Mental Health Act Commission 56 Milton Keynes PCT 57 National Childbirth Trust 58 National Patient Safety Agency (NPSA) Diarrhoea and vomiting: full guideline DRAFT October 2008 page 5 of 193 DRAFT FOR CONSULTATION 1 National Pharmacy Association 2 National Public Health Service - Wales 3 National Treatment Agency for Substance Misuse 4 NCCHTA 5 NCCHTA 6 NCCHTA 7 Neonatal & Paediatric Pharmacists Group (NPPG) 8 Newham University Hospital NHS Trust 9 NHS Clinical Knowledge Summaries Service (SCHIN) 10 NHS Direct 11 NHS Kirklees 12 NHS Plus 13 NHS Purchasing & Supply Agency 14 NHS Quality Improvement Scotland 15 Norgine Ltd 16 North Yorkshire and York PCT 17 Northwick Park and St Mark’s Hospitals NHS Trust 18 Nottingham University Hospitals NHS Trust 19 PERIGON Healthcare Ltd 20 Queen’s Medical Centre Nottingham University Hospitals NHS Trust 21 Royal College of General Practitioners 22 Royal College of Midwives 23 Royal College of Nursing 24 Royal College of Paediatrics and Child Health 25 Royal College of Pathologists 26 Royal College of Radiologists 27 Royal Liverpool Childrens NHS Trust 28 SACAR 29 Sandwell PCT 30 Sanofi Pasteur MSD 31 Sanofi-Aventis 32 Scottish Intercollegiate Guidelines Network (SIGN) 33 Scottish Nutrition & Diet Resources Initiative 34 Sedgefield PCT 35 Sefton PCT 36 Sheffield PCT 37 Sheffield Teaching Hospitals NHS Foundation Trust 38 Social Care Institute for Excellence (SCIE) 39 South Central Ambulance Service NHS Trust 40 Staffordshire Ambulance HQ 41 The Phoenix Partnership 42 The Royal Society of Medicine 43 University College London Hospitals (UCLH) Acute Trust 44 Welsh Assembly Government 45 Welsh Scientific Advisory Committee (WSAC) 46 Western Cheshire Primary Care Trust 47 Western Health and Social Care Trust 48 Wiltshire PCT 49 Wirral Hospital Acute Trust 50 York NHS Foundation Trust 51 52 Diarrhoea and vomiting: full guideline DRAFT October 2008 page 6 of 193 DRAFT FOR CONSULTATION 1 Abbreviations 2 C. diff Clostridium difficile 3 CI Confidence Interval 4 CRP C-reactive protein 5 CRT Capillary Refill Time 6 DCRT Digital Capillary Refill Time 7 DGH District General Hospital (non-teaching hospital) 8 EL Evidence Level (level of evidence) 9 ELISA Enzyme-Linked ImmunoSorbent Assay 10 ESR Erythrocyte Sedimentation Rate 11 ESPGHAN The European Society for Paediatric Gastroenterology 12 GDG Guideline Development Group 13 GPP Good Practice Point 14 HE Health Economics 15 HPA Health Protection Agency 16 IVT Intravenous rehydration Therapy 17 NCC-WCH National Collaborating Centre for Women’s and Children’s Health 18 NHS National Health Service 19 NICE National Institue for Health and Clinical Excellence 20 NPSA National Patient Safety Agency 21 OR Odds Ratio 22 ORS Oral Rehydration Solution 23 ORT Oral Rehydration Therapy 24 PPIP Patient and Public Involvement Programme 25 QALYs Quality Adjusted Life Years 26 RCT Randomised Controlled Trial 27 RR Relative Risk 28 SD Standard Deviation 29 UK United Kingdom 30 USA United States of America 31 UTI Urinary Tract Infection 32 WHO World Health Organisation 33 WMD Weighted Mean Difference Diarrhoea and vomiting: full guideline DRAFT October 2008 page 7 of 193 DRAFT FOR CONSULTATION 1 Glossary of terms 2 Absolute risk Measures the probability of an event or outcome occurring (e.g.
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