World Journal of Pediatrics

, Volume 14, Issue 5, pp 429–436 | Cite as

Chinese clinical practice guidelines for acute infectious diarrhea in children

  • Jie ChenEmail author
  • Chao-Min Wan
  • Si-Tang Gong
  • Feng Fang
  • Mei Sun
  • Yuan Qian
  • Ying Huang
  • Bao-Xi Wang
  • Chun-Di Xu
  • Li-Yan Ye
  • Mei Dong
  • Yu Jin
  • Zhi-Hua Huang
  • Qin-Bing Wu
  • Chao-Min Zhu
  • You-Hong Fang
  • Qi-Rong Zhu
  • Yong-Sui Dong
Review Article



The guidelines addressed the evidence-based indications for the management of children with acute infectious diarrhea in Chinese pediatric population.

Data sources

The experts group of evidence development put forward clinical problems, collects evidence, forms preliminary recommendations, and then uses open-ended discussions to form recommendations. The literature review was done for developing this guideline in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to June 2013. Search the topic “acute diarrhea” or “enteritis” and “adolescent” or “child” or “Pediatric patient” or “Baby” or “Infant”.


For the treatment of mild, moderate dehydration, hypotonic oral rehydration solutions (ORS) are strongly recommended. Intravenous (IV) rehydration is recommended for severe dehydration, with a mixture of alkali-containing dextrose sodium solution. Nasogastric feeding tube rehydration is used for children with severe dehydration without IV infusion conditions with ORS solution. Regular feeding should resume as soon as possible after oral rehydration or IV rehydration. The lactose-free diet can shorten the diarrhea duration. Zinc supplements are recommended in children with acute infectious diarrhea. Saccharomyces boulardii and Lactobacillus Rhamnus are recommended to be used in acute watery diarrhea. Saccharomyces boulardii is recommended in children with antibiotic-associated diarrhea as well. Montmorillonite and Racecadotril (acetorphan) can improve the symptoms of diarrhea or shorten the course of acute watery diarrhea. Antibiotics are recommended with dysenteric-like diarrhea, suspected cholera with severe dehydration, immunodeficiency, and premature delivery children with chronic underlying disease; otherwise, antibiotics are not recommended.


The principles of the most controversial treatments with of acute infectious disease are reaching to a consensus in China.


Children Diarrhea Dehydration Infection Rehydration Treatment Probiotics 


Author contributions

CJ designed the manuscript, CJ and FYH drafted and revised the final manuscript. WCM carried out the evidence based methodology. All the other authors collected data and wrote one part of the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. All authors contributed equally to this paper.



Compliance with ethical standards

Ethical approval

Not required for this guideline.

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.


  1. 1.
    Lin M, Dong BQ. Status in epidemiological research of infectious diarrhea. China Trop Med. 2008;8:675–7 (in Chinese).CrossRefGoogle Scholar
  2. 2.
    Grondin SC, Schieman C. Evidence-based medicine: levels of evidence and evaluation systems, 12th ed. London: Springer; 2011. p. 13–22.Google Scholar
  3. 3.
    Sackett D, Straus S, Richardson W, Rosenberg W, Haynes R. Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.Google Scholar
  4. 4.
    American Academy of Pediatrics Steering Committee on Quality. Improvement and management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114:874–7. CrossRefGoogle Scholar
  5. 5.
    Academic Group of Pediatric gastroenterology of Chinese Pediatrics Association, Editorial Board of Chinese Journal of Pediatrics. Experts’ consensus on the principles of diagnosis and treatment of diarrheal diseases in children. Clin J Pediatr. 2009;47:634–6.Google Scholar
  6. 6.
    Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. J Pediatr Gastroenterol Nutr. 2008;46:619–21.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    World Health Organization. The treatment of diarrhea: a manual for physicians and other senior health works. 2018. Accessed 29 Aug 2018.
  8. 8.
    van den Berg J, Berger MY. Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care. BMC Fam Pract. 2011;12:134.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    World Gastroenterology Organization. World Gastroenterology Organization (WGO) practice guideline: acute diarrhea. Munich, Germany. 2008. p. 28. Accessed 29 Aug 2018.
  10. 10.
    Mei S, Juan F, Guihua C, Chaomin W. Evidence based management of childhood acute diarrhea. J Clin Pediatr. 2008;26:627–32.Google Scholar
  11. 11.
    Fubao Y. Clinical study on infantile lactose intolerance. J Clin Pediatr. 2010;28:496–8.Google Scholar
  12. 12.
    Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De VA, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ. 2007;335:340–2.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Song H, Dechun Z, Fang C, Fanghong G, Yanan G. Meta analysis of Bifid-preparations in prevention of secondary diarrhea in infants in China. Chin J Microecol. 2009;21:692–5 (in Chinese).Google Scholar
  14. 14.
    Szajewska H, Skorka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther. 2007;25:257–64.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Narayanappa D. Randomized double blinded controlled trial to evaluate the efficacy and safety of Bifilac in patients with acute viral diarrhea. Indian J Pediatr. 2008;75:709–13.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrheoa. Cochrane Datab Syst Rev. 2010;10(11):CD003048.Google Scholar
  17. 17.
    Madkour AA, Madina EM, El-Azzouni OE, Amer MA, El-Walili TM, Abbass T. Smectite in acute diarrhea in children: a double-blind placebo-controlled clinical trial. J Pediatr Gastroenterol Nutr. 1993;17:176–81.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Dupont C, Foo JLK, Garnier P, Moore N, Mathiex-Fortunet H, Salazar-Lindo E. Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea. Clin Gastroenterol Hepatol. 2009;7:456–62.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Szajewska H, Dziechciarz P, Mrukowicz J. Meta-analysis: smectite in the treatment of acute infectious diarrhoea in children. Aliment Pharmacol Ther. 2006;23:217–27.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Santos M, Marañón R, Miguez C, Vázquez P, Sánchez C. Use of racecadotril as outpatient treatment for acute gastroenteritis: a prospective, randomized, parallel study. J Pediatr. 2009;155:62–7.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Chacón J. Analysis of factors influencing the overall effect of racecadotril on childhood acute diarrhea. Results from a real-world and post-authorization surveillance study in Venezuela. Ther Clin Risk Manag. 2010;6:293–9.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–61.CrossRefGoogle Scholar
  23. 23.
    Daikun L, Yong H, Weiling F, Dechun Z. Pathogenic bacteria of infantile diarrhea and their drug resistance. Int J Lab Med. 2010;31:322–4.Google Scholar
  24. 24.
    Vukelic D, Trkulja V, Salkovic-Petrisic M. Single oral dose of azithromycin versus 5 days of oral erythromycin or no antibiotic in treatment of campylobacter enterocolitis in children: a prospective randomized assessor-blind study. J Pediatr Gastroenterol Nutr. 2010;12:e78–9.Google Scholar
  25. 25.
    Orth D, Grif K, Zimmerhackl LB, Würzner R. Prevention and treatment of enterohemorrhagic Escherichia coli infections in humans. Expert Rev Anti Infect Ther. 2008;6:101–8.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018

Authors and Affiliations

  • Jie Chen
    • 1
    Email author
  • Chao-Min Wan
    • 2
  • Si-Tang Gong
    • 3
  • Feng Fang
    • 4
  • Mei Sun
    • 5
  • Yuan Qian
    • 6
  • Ying Huang
    • 7
  • Bao-Xi Wang
    • 9
  • Chun-Di Xu
    • 10
  • Li-Yan Ye
    • 11
  • Mei Dong
    • 12
  • Yu Jin
    • 13
  • Zhi-Hua Huang
    • 4
  • Qin-Bing Wu
    • 14
  • Chao-Min Zhu
    • 15
  • You-Hong Fang
    • 1
  • Qi-Rong Zhu
    • 8
  • Yong-Sui Dong
    • 3
  1. 1.Department of Gastroenterology, Children’s HospitalZhejiang University School of MedicineHangzhouChina
  2. 2.Department of Pediatrics, West China Second HospitalSichuan UniversityChengduChina
  3. 3.Department of GastroenterologyGuangzhou Women and Children’s Medical CenterGuangzhouChina
  4. 4.Department of Pediatrics, Tongji Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  5. 5.Department of GastroenterologyShengjing Hospital of China Medical UniversityShenyangChina
  6. 6.Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in ChildrenCapital Institute of PediatricsBeijingChina
  7. 7.Department of GastroenterologyChildren’s Hospital of Fudan UniversityShanghai 201102China
  8. 8.Department of Infectious DiseasesChildren’s Hospital of Fudan UniversityShanghaiChina
  9. 9.Department of Pediatrics, Tangdu HospitalThe Fourth Military Medical UniversityXi’anChina
  10. 10.Department of Pediatrics, Ruijin Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
  11. 11.Department of PediatricsFuzhou East HospitalFuzhouChina
  12. 12.Department of PediatricsPeking Union Medical College HospitalBeijingChina
  13. 13.Department of GastroenterologyChildren’s Hospital of Nanjing Medical UniversityNanjingChina
  14. 14.Department of GastroenterologyChildren’s Hospital of Soochow UniversitySuzhouChina
  15. 15.Department of Infectious DiseasesChildren’s Hospital of Chongqing Medical UniversityChongqingChina

Personalised recommendations