Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials

Abstract

Objective: To define the benefit of rice oral rehydration salts solution in relation to the glucose based World Health Organisation oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea.

Design: Meta-analysis using data from 13 available randomised trials that compared these two formulations.

Subjects: The studies compared 1367 patients with cholera, severe cholera-like diarrhoea, or acute non-cholera diarrhoea. 668 received the standard WHO solution and 699 the rice based solution.

Intervention: Each trial report was reviewed to determine patient eligibility, the number of patients who were randomised and the number of these excluded from analysis, details of the randomisation procedure, and the precise timing of the outcome measurements.

Main outcome measures: Stool output during the first 24 hours; weighted estimates of the difference in mean stool output between treatments.

Results: The rice solution significantly reduced the rate of stool output during the first 24 hours by 36% (95% confidence interval 28 to 44%) in adults with cholera and by 32% (19 to 45%) in children with cholera. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only 18% (6 to 30%).

Conclusions: The benefit of rice oral rehydration salts solution for patients with cholera is sufficiently great to warrant its use in such patients. The benefit is considerably smaller for children with acute, noncholera diarrhoea and should be more precisely defined before its practical value can be judged.

PIP: This meta-analysis used data from 13 available randomized trials to compare 2 rehydration salts solutions. Specifically, it sought to define the benefit of rice oral rehydration salts in relation to the glucose-based WHO oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhea. The studies compared 1367 patients with cholera, severe cholera-like diarrhea, or acute noncholera diarrhea; 668 received the standard WHO solution and 699 the rice based one. Each report was reviewed to determine patient eligibility, the number of patients who were randomized, and the number of these excluded from the analysis, details of the randomization procedure, and the precise timing of the outcome measurements. Stool output during the 1st 24 hours was measured and there were weighted estimates of the differences in mean stool output between treatments. The rice solution significantly reduced the rate of stool output during the 1st 24 hours by 36% (95% confidence interval 28-44%) in adults with cholera and by 32% (19-45%) in children with cholera. The rate of stool loss in infants and children with acute noncholera diarrhea was reduced by only 18% (6-30%). The benefit of rice oral rehydration salts solution for patients with cholera is sufficiently great to warrant its use in these patients. The benefit is considerably less for children with acute, noncholera diarrhea and should be more precisely defined before its practical value can be judge.