Clinical practice guidelines for acute infectious diarrhea in children in China (2024)

doi:10.1007/s12519-025-00894-7

Practice Guideline

. 2025 Jul;21(7):708-719.

doi: 10.1007/s12519-025-00894-7. Epub 2025 May 29.

Clinical practice guidelines for acute infectious diarrhea in children in China (2024)

You-Hong Fang¹, Chao-Min Wan², Si-Tang Gong³, Feng Fang⁴, Mei Sun⁵, Yuan Qian⁶, Ying Huang⁷, Bao-Xi Wang⁸, Chun-Di Xu⁹, Yu Jin¹⁰, Li-Yan Ye¹¹, Sai-Nan Shu¹², Qing-Bin Wu¹³, Jie Wu¹⁴, Xiao-Qin Li¹⁵, Jing-Fang Chen¹⁶, Hong-Mei Xu¹⁷, Zheng-Hong Li¹⁸, Hui Yu¹⁹, Ji-Kui Deng²⁰, Jie Chen²¹

Affiliations

¹ Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China.
² Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China.
³ Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
⁴ Department of Pediatrics, Tongji Hospital, Tongji Medical Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁵ Shengjing Hospital of China Medical University, Shenyang, China.
⁶ Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Beijing, China.
⁷ Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
⁸ Department of Pediatrics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
⁹ Department of Pediatrics, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China.
¹¹ The 900, Hospital of Joint Logistic Support Force, Fuzhou, China.
¹² Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
¹³ Department of Gastroenterology, Children's Hospital of Soochow University, Suzhou, China.
¹⁴ Department of Gastroenterology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
¹⁵ Department of Gastroenterology, Henan Children's Hospital, Zhengzhou, China.
¹⁶ Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China.
¹⁷ Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
¹⁹ Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
²⁰ Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China.
²¹ Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China. 6185020@zju.edu.cn.

PMID: 40437180
DOI: 10.1007/s12519-025-00894-7

Practice Guideline

Clinical practice guidelines for acute infectious diarrhea in children in China (2024)

You-Hong Fang et al. World J Pediatr. 2025 Jul.

. 2025 Jul;21(7):708-719.

doi: 10.1007/s12519-025-00894-7. Epub 2025 May 29.

Authors

Affiliations

¹ Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China.
² Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China.
³ Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
⁴ Department of Pediatrics, Tongji Hospital, Tongji Medical Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁵ Shengjing Hospital of China Medical University, Shenyang, China.
⁶ Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Beijing, China.
⁷ Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
⁸ Department of Pediatrics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
⁹ Department of Pediatrics, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China.
¹¹ The 900, Hospital of Joint Logistic Support Force, Fuzhou, China.
¹² Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
¹³ Department of Gastroenterology, Children's Hospital of Soochow University, Suzhou, China.
¹⁴ Department of Gastroenterology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
¹⁵ Department of Gastroenterology, Henan Children's Hospital, Zhengzhou, China.
¹⁶ Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China.
¹⁷ Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
¹⁹ Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
²⁰ Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China.
²¹ Department of Gastroenterology, School of Medicine, Children's Hospital of Zhejiang University, National Clinical Research Center for Child Health, 3333 Bin Sheng Road, Hangzhou 310052, China. 6185020@zju.edu.cn.

PMID: 40437180
DOI: 10.1007/s12519-025-00894-7

Abstract

Background: Some new progress and evidence have been made in the diagnosis and treatment of pediatric acute infectious diarrhea since the publication of the "Chinese clinical practice guidelines for acute infectious diarrhea in children" (2018 edition guidelines). The updated "Chinese clinical practice guidelines for acute infectious diarrhea in children" incorporates new evidence-based recommendations for managing acute infectious diarrhea in the Chinese pediatric population.

Data sources: Building on the 2018 edition guidelines, expert panels reviewed clinical evidence, assessed preliminary recommendations, and conducted open-ended discussions to finalize the updated guidelines. These guidelines are founded on the latest literature and evidence-based practices. A literature review was performed in databases such as PubMed, Cochrane, EMBASE, China Biomedical Database, and the Chinese Journal Full-text Database up to June 2024. The search focused on the terms "acute diarrhea" or "enteritis", along with "adolescent", "child", "pediatric patient", "baby", or "infant".

Results: The updated guidelines address various aspects of acute infectious diarrhea, including diagnosis, etiological evaluation, dehydration assessment, fluid therapy, diet therapy, medical therapy, and prevention strategies. The main updates focused on etiological diagnosis and the use of probiotics, racecadotril, zinc, and antibiotics in treating acute infectious diarrhea.

Conclusions: The updated guidelines address disputed treatments for acute infectious diarrhea through evidence-based revisions. Standardized etiological evaluations guide management. Probiotics are moderately advised for viral watery diarrhea; racecadotril remains unsupported. Zinc supplementation is recommended for children >6 months in deficient regions. Antibiotics are restricted to cases with dysenteric-like symptoms, suspected cholera with severe dehydration, or comorbidities.

Keywords: Fluid therapy; Infectious diarrheal disease; Pediatrics; Practice guideline; Probiotics.

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Conflict of interest statement

Declarations. Ethical approval: Not needed. Conflict of interest: No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflicts of interest to declare.

References

1. Mughini-Gras L, Pijnacker R, Heusinkveld M, Enserink R, Zuidema R, Duizer E, et al. Societal burden and correlates of acute gastroenteritis in families with preschool children. Sci Rep. 2016;6:22144.
1. Chen J, Wan CM, Gong ST, Fang F, Sun M, Qian Y, et al. Chinese clinical practice guidelines for acute infectious diarrhea in children. World J Pediatr. 2018;14:429–36.
1. Grondin SC, Schieman C. Evidence-based medicine: levels of evidence and evaluation systems. 12th ed. London: Springer; 2011. p. 13–22.
1. Sackett DL, Straus SE, Scott Richardson W, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.
1. American Academy of Pediatrics Steering Committee on Quality Improvement and management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114:874–7.

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[1] Mughini-Gras L, Pijnacker R, Heusinkveld M, Enserink R, Zuidema R, Duizer E, et al. Societal burden and correlates of acute gastroenteritis in families with preschool children. Sci Rep. 2016;6:22144.

[2] Mughini-Gras L, Pijnacker R, Heusinkveld M, Enserink R, Zuidema R, Duizer E, et al. Societal burden and correlates of acute gastroenteritis in families with preschool children. Sci Rep. 2016;6:22144.

[3] Chen J, Wan CM, Gong ST, Fang F, Sun M, Qian Y, et al. Chinese clinical practice guidelines for acute infectious diarrhea in children. World J Pediatr. 2018;14:429–36.

[4] Chen J, Wan CM, Gong ST, Fang F, Sun M, Qian Y, et al. Chinese clinical practice guidelines for acute infectious diarrhea in children. World J Pediatr. 2018;14:429–36.

[5] Grondin SC, Schieman C. Evidence-based medicine: levels of evidence and evaluation systems. 12th ed. London: Springer; 2011. p. 13–22.

[6] Grondin SC, Schieman C. Evidence-based medicine: levels of evidence and evaluation systems. 12th ed. London: Springer; 2011. p. 13–22.

[7] Sackett DL, Straus SE, Scott Richardson W, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.

[8] Sackett DL, Straus SE, Scott Richardson W, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.

[9] American Academy of Pediatrics Steering Committee on Quality Improvement and management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114:874–7.

[10] American Academy of Pediatrics Steering Committee on Quality Improvement and management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114:874–7.

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Clinical practice guidelines for acute infectious diarrhea in children in China (2024)

Affiliations

Clinical practice guidelines for acute infectious diarrhea in children in China (2024)

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Conflict of interest statement

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