Polymer‐based oral rehydration solution for treating acute watery diarrhoea

Germana V Gregorio; Maria Liza M Gonzales; Leonila F Dans; Elizabeth G Martinez

doi:10.1002/14651858.CD006519.pub2

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Figure 1

Any polymer‐based ORS vs glucose‐based ORS: unscheduled use of intravenous fluid.

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Figure 2

Rice‐based ORS vs glucose‐based ORS: duration of diarrhoea, by age group.

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Figure 3

Funnel plot on the trials of polymer‐based ORS vs glucose‐based ORS, measuring the outcome of unscheduled use of intravenous fluid.

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Analysis 1.1

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 1 Total stool output: during first 24 hours.

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Analysis 1.2

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 2 Duration of diarrhoea.

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Analysis 1.3

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 3 Unscheduled use of intravenous fluid.

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Analysis 1.4

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 4 Vomiting (no. participants).

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Analysis 1.5

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 5 Hyponatraemia (no. participants).

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Analysis 1.6

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 6 Hypokalaemia (no. participants).

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Analysis 1.7

Comparison 1 Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS, Outcome 7 Developed persistent diarrhoea (no. participants).

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Analysis 2.1

Comparison 2 Type of polymer: polymer‐based ORS vs glucose‐based ORS, Outcome 1 Total stool output during the first 24 hours.

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Analysis 2.2

Comparison 2 Type of polymer: polymer‐based ORS vs glucose‐based ORS, Outcome 2 Duration of diarrhoea.

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Analysis 2.3

Comparison 2 Type of polymer: polymer‐based ORS vs glucose‐based ORS, Outcome 3 Unscheduled use of intravenous fluid.

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Analysis 3.1

Comparison 3 Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS, Outcome 1 Total stool output during the first 24 hours, by age group.

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Analysis 3.2

Comparison 3 Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS, Outcome 2 Duration of diarrhoea, by age group.

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Analysis 3.3

Comparison 3 Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS, Outcome 3 Total stool output during the first 24 hours, by pathogen.

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Analysis 3.4

Comparison 3 Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS, Outcome 4 Duration of diarrhoea, by type of pathogen.

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Comparison 1. Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total stool output: during first 24 hours Show forest plot	13		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 ORS ≥310	12		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 ORS ≤ 270	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 Duration of diarrhoea Show forest plot	15		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 ORS ≥ 310	12		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 ORS ≤ 270	3		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 Unscheduled use of intravenous fluid Show forest plot	21	2235	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.59, 0.95]

3.1 ORS ≥ 310	18	1909	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.60, 1.01]
3.2 ORS ≤ 270	3	326	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.36, 1.08]
4 Vomiting (no. participants) Show forest plot	10	617	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.65, 1.05]

4.1 ORS ≥ 310	9	554	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.68, 1.11]
4.2 ORS ≤ 270	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.24, 1.34]
5 Hyponatraemia (no. participants) Show forest plot	6	480	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.52, 2.01]

5.1 ORS ≥ 310	3	335	Risk Ratio (M‐H, Fixed, 95% CI)	2.25 [0.34, 14.92]
5.2 ORS ≤ 270	3	145	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.43, 1.82]
6 Hypokalaemia (no. participants) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 ORS ≥ 310	2	260	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.74, 2.25]
7 Developed persistent diarrhoea (no. participants) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7.1 ORS ≥ 310	2	885	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.68, 2.41]

Comparison 1. Type of glucose ORS: any polymer‐based ORS vs glucose‐based ORS

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Comparison 2. Type of polymer: polymer‐based ORS vs glucose‐based ORS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total stool output during the first 24 hours Show forest plot	17		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 Rice‐based ORS	13		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Wheat‐based ORS	2		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 Sorghum‐based ORS	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.4 Maltodextrin‐based ORS	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 Duration of diarrhoea Show forest plot	18		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Rice‐based ORS	15		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Wheat‐based ORS	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.3 Sorghum‐based ORS	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.4 Maltodextrin‐based ORS	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 Unscheduled use of intravenous fluid Show forest plot	21	2168	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.59, 0.97]

3.1 Rice‐based ORS	18	1962	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.58, 0.98]
3.2 Wheat‐based ORS	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.53]
3.3 Maltodextrin‐based ORS	2	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.31, 2.02]

Comparison 2. Type of polymer: polymer‐based ORS vs glucose‐based ORS

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Comparison 3. Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total stool output during the first 24 hours, by age group Show forest plot	13		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 Paediatric	11		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Adults	2		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 Duration of diarrhoea, by age group Show forest plot	15	998	Mean Difference (IV, Random, 95% CI)	‐7.19 [‐11.80, ‐2.58]

2.1 Paediatrics	11	770	Mean Difference (IV, Random, 95% CI)	‐6.81 [‐12.10, ‐1.52]
2.2 Adults	4	228	Mean Difference (IV, Random, 95% CI)	‐7.11 [‐11.91, ‐2.32]
3 Total stool output during the first 24 hours, by pathogen Show forest plot	11		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Cholera	3		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Non‐cholera	4		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.3 Mixed pathogens	5		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 Duration of diarrhoea, by type of pathogen Show forest plot	12		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Cholera	7		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 Non‐cholera	3		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 Mixed pathogens	2		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Effects of age and pathogen: rice‐based ORS vs glucose‐based ORS

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