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Meta-analysis: smectite in the treatment of acute infectious diarrhoea in children

Aliment Pharmacol Ther. 2006 Jan 15;23(2):217-27.

Szajewska H, Dziechciarz P, Mrukowicz J.

Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland. hania@ipgate.pl

BACKGROUND: Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrhoea in many countries. 

AIM: To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhoea in children. 

METHODS: Using medical subject headings and free-language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhoea and smectite: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials were included. 

RESULTS: Nine randomized-controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized-controlled trials showed that smectite significantly reduced the duration of diarrhoea compared with placebo. The pooled weighted mean difference was (-22.7 h, 95% CI: -24.8 to -20.6) with a fixed model and remained significant in a random effect model (-24.4 h, 95% CI: -29.8 to -19.1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1.64, 95% CI: 1.36-1.98; number needed to treat 4, 95% CI: 3-5). Adverse effects were similar in both groups. 

CONCLUSIONS: Smectite may be a useful adjunct to rehydration therapy in treating acute paediatric gastroenteritis. However, the results of this meta-analysis should be interpreted with caution as most of the included studies had important limitations. Cost-effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended.

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