2024中国临床实践指南：儿童急性感染性腹泻（英文）解读

Interpretationof2024ChineseClinicalPracticeGuidelinesforAcuteInfectiousDiarrheainChildren

1.BackgroundandSignificanceoftheGuidelines

Acuteinfectiousdiarrhearemainsaleadingcauseofmorbidityandmortalityinchildrenunder5yearsoldinChina,imposingaheavyburdenonpublichealthandfamilies.The2024updateoftheguidelinesintegratesthelatestdomesticandinternationalevidence-basedmedicalresearchresults,adjustsandoptimizesdiagnosis,treatmentandpreventionstrategies,aimingtostandardizeclinicalpractice,improvetheprognosisofchildrenwithacuteinfectiousdiarrhea,andreducetheincidenceofcomplicationsandmortality.

2.CoreRecommendationsonDiagnosis

2.1ClinicalAssessmentofSymptoms

Theguidelinesemphasizethatthediagnosisofacuteinfectiousdiarrheashouldbebasedonclinicalmanifestationscombinedwithepidemiologicalhistory.Keysymptomsinclude:(1)Abnormalstoolcharacteristics:increasedfrequency(≥3times/day)orchangedconsistency(loose,watery,bloodystools);(2)Associatedsymptoms:fever,vomiting,abdominalpain,dehydrationsigns(drymucousmembranes,sunkenfontanelleininfants,decreasedurineoutput,lethargy);(3)Epidemiologicalclues:historyofcontactwithdiarrheapatients,consumptionofcontaminatedfoodorwater,travelhistorytoendemicareas.

2.2IndicationsforLaboratoryTests

Theguidelinesclearlydefinethescopeofunnecessaryandnecessarylaboratoryteststoavoidover-examination:(1)Routinestooltestsandstoolculturearenotrecommendedformild,non-bloodydiarrheawithoutsystemicsymptoms;(2)Stoolculture,PCRorantigendetectionshouldbeperformedincasesofbloodydiarrhea,severedehydration,persistenthighfever,immunocompromisedchildren,orsuspectedoutbreaks;(3)Bloodroutine,electrolyteandrenalfunctiontestsarerequiredforchildrenwithmoderatetoseveredehydrationorsuspectedsystemicinfectiontoevaluatetheseverityofthediseaseandguidetreatment.

3.KeyRecommendationsonTreatment

3.1FluidTherapy(FirstPriority)

Fluidtherapyisthecoreoftreatingacuteinfectiousdiarrhea,andtheguidelinesprovidedetailedoperationalrecommendations:(1)Oralrehydration:ORSIIIisthefirstchoice.Forchildrenwithoutdehydration,50mL(under6months),100mL(6-24months),150mL(2-10yearsold)oradlibitum(over10yearsold)shouldbegivenaftereachloosestool,foratotalof100-150mL/kgwithin4hours.Forchildrenwithmildtomoderatedehydration,oralrehydrationshouldbecompletedwithin4-6hours,followedbymaintenancefluidsupply;(2)Intravenousrehydration:Indicatedforchildrenwithseveredehydration,shock,orinabilitytotolerateoralrehydration.Theinitialinfusionrateis20mL/kg(isotoniccrystalloidsolution)within30minutesforshockcorrection,thenadjustedaccordingtodehydrationdegreeandelectrolyteresults;(3)Rehydrationmonitoring:Closelyobservechangesinmentalstate,urineoutput,anddehydrationsignsduringrehydration,andadjusttheplaninatimelymanner.

3.2NutritionalSupport

Theguidelinesopposethetraditionalpracticeoffastingandemphasizeearlynutritionalintervention:(1)Continueregulardiet:Infantsshouldcontinuebreastfeeding;formula-fedinfantscanuseregularformula;olderchildrencaneateasilydigestiblefoods(riceporridge,noodles,steamedbread)andavoidhigh-sugar,high-fat,andspicyfoods;(2)Managementoflactoseintolerance:Forchildrenwithpersistentdiarrheaorsuspectedlactoseintolerance,lactose-freeformulaorlactasecanbeusedtemporarily,andgraduallytransitiontoanormaldietaftersymptomsimprove;(3)Micronutrientsupplementation:RoutinesupplementationofvitaminA(200,000IUforchildrenover6months,100,000IUforinfantsunder6months)isrecommendedtoreducetheseverityanddurationofdiarrhea.

3.3PharmacologicalTreatment

Theguidelinesstrictlystandardizetheuseofdrugstoavoidabuse:(1)Zincsupplementation:Mandatoryforallchildrenwithacuteinfectiousdiarrhea,withadosageof10mg/dayforchildrenunder6monthsand20mg/dayforchildrenover6months,foracourseof10-14days.Zinccanshortenthedurationofdiarrheaandreducetheriskofrecurrence;(2)Probiotics:Recommendedforchildrenwithwaterydiarrheatoshortenthecourseofthedisease.RecommendedstrainsincludeSaccharomycesboulardii,LactobacillusrhamnosusGG,etc.,withacourseof5-7days;(3)Montmorillonitepowder:Canbeusedforchildrenwithseverewaterydiarrheatoreducestoolfrequency,butshouldbetakenseparatelyfromotherdrugsby1-2hours;(4)Antibiotics:Onlyindicatedforspecificbacterialinfections,suchasbloodydiarrheacausedbyShigella,severeSalmonellainfection,Campylobacterjejuniinfectioninimmunocompromisedchildren.Antibioticsarestrictlyprohibitedforviraldiarrhea(suchasrotavirus,norovirus)andnon-severebacterialdiarrhea;(5)Antidiarrhealdrugs(suchasloperamide):Contraindicatedinchildrenunder6yearsoldduetotheriskofseriousadversereactions.

3.4ManagementofSpecialPopulations

Forhigh-riskgroups,theguidelinesproposetargetedmeasures:(1)Malnourishedchildren:Strengthennutritionalsupport,increaseproteinandenergyintake,andcontinuezincandvitaminAsupplementationforalongerperiod;(2)Immunocompromisedchildren:Lowerthethresholdforantibioticuse,closelymonitorinfectionprogression,andconsiderprolongedtreatmentcourses;(3)Childrenwithchronicunderlyingdiseases(suchascongenitalheartdisease,chronickidneydisease):Adjustfluidanddrugtreatmentplansaccordingtotheunderlyingdiseasetoavoidaggravatingtheoriginalcondition.

4.RecommendationsonPrevention

Theguidelinesemphasizecomprehensivepreventionmeasuresfrommultipledimensions:(1)Vaccination:Rotavirusvaccineisthemosteffectivemeasuretopreventsevererotavirusdiarrhea,anditisrecommendedtocompletevaccinationbefore6monthsofage;(2)Infectioncontrol:Strengthenhandhygiene(especiallybeforeeatingandafterusingthetoilet),disinfectcontaminateditemsandenvironments,andisolatepatientstoavoidoutbreaksincollectiveplacessuchaskindergartens;(3)Healtheducation:Guideparentstocorrectlyrecognizethesymptomsofdiarrhea,avoidblinduseofantibioticsandantidiarrhealdrugs,andmasterthemethodsoforalrehyd