Evidence-based child health : a Cochrane review journal
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Evid Based Child Health · Jul 2013
ReviewPropofol versus thiopental sodium for the treatment of refractory status epilepticus (Review).
Failure to respond to antiepileptic drugs in uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome. ⋯ There is lack of robust and randomised controlled evidence that can clarify the efficacy of propofol and thiopental sodium over each other in the treatment of RSE. There is a need for large, randomised controlled trials for this serious condition.
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Evid Based Child Health · Jul 2013
ReviewProphylactic drug management for febrile seizures in children (Review).
Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. ⋯ No clinically important benefits for children with febrile seizures were found for intermittent oral diazepam, phenytoin, phenobarbitone, intermittent rectal diazepam, valproate, pyridoxine, intermittent phenobarbitone or intermittent ibuprofen, nor for diclofenac versus placebo followed by ibuprofen, acetominophen or placebo. Adverse effects were reported in up to 30% of children. Apparent benefit for clobazam treatment in one recent trial needs to be replicated to be judged reliable. Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon.
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Evid Based Child Health · Jul 2013
ReviewTreatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries.
Acute gastroenteritis (AGE) is an extremely common paediatric condition, which results in significant morbidity in children and is a financial burden to the society. ⋯ Given that oral rehydration is less invasive than IV rehydration with no evidence of important clinical differences, it is the first choice for rehydration in children with AGE and mild-to-moderate dehydration. As the vast majority of children with AGE do not require IV rehydration, oral ondansetron administration to children with significant vomiting should be performed to reduce the use of IV rehydration and the need for hospital admission. In children deemed too unwell to receive oral rehydration therapy, IV ondansetron administration is an option, as its use is associated with lower hospital admission rates. Although probiotics appear to be an effective option for the treatment of AGE amongst hospitalized children, outpatient data is lacking and more studies are urgently needed to determine the optimal organism, dosing and duration of treatment.
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Evid Based Child Health · Jul 2013
CommentCommentary on ‘propofol versus thiopental sodium for the treatment of refractory status epilepticus—still no answer’.
This is a commentary on a Cochrane review, published in this issue of EBCH, first published as:Prabhakar H, Bindra A, Singh GP, Kalaivani M. Propofol versus thiopental sodium for the treatment ofrefractory status epilepticus. Cochrane Database of Systematic Reviews 2012, Issue 8. ⋯ No.: CD009202. DOI: 10.1002/14651858. CD009202.pub2.
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Evid Based Child Health · Jul 2013
CommentCommentaries on 'procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections' with a response from the review authors.
These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Schuetz P, Müller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bhatnagar N, Bucher HC, Briel M. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database of Systematic Reviews 2012, Issue 9. ⋯ No.: CD007498. DOI: 10.1002/14651858. CD007498.pub2.