ORAL REHYDRATION THERAPY FOR DIARRHEA - AN EXAMPLE OF REVERSE TRANSFER OF TECHNOLOGY

On November 13 and 14, 1996, a scientific symposium on oral rehydratio n therapy (ORT) was held at the Johns Hopkins University School of Hyg iene and Public Health in Baltimore, MD. The purpose of the meeting wa s to review the current treatment practices for the treatment of this disease in the United States. The group noted that diarrhea resulted i n 300 to 400 deaths per year among children, similar to 200 000 hospit alizations, 1.5 million outpatient visits, and costs >$1 billion in di rect medical costs. ORT is well established therapy for the treatment and prevention of dehydration due to diarrhea. The principles of ORT t reatment include early adequate rehydration therapy using an appropria te oral rehydration solution (ORS), replacement of ongoing fluid losse s from vomiting and diarrhea with ORS, and frequent feeding of appropr iate foods as soon as dehydration is corrected. The effective use of O RT has saved millions of lives around the world. However, in the Unite d States, ORT is grossly underused. Contrary to the recommendations of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), health care providers overuse intravenou s hydration, prolong rehydration, delay reintroduction of feeding, and inappropriately withhold ORT, especially with children who are vomiti ng. The expert panel noted that the majority of deaths, hospitalizatio n, and visits to emergency departments could be prevented by the appro priate use of ORT. They generated guidelines for the treatment and pre vention of dehydration secondary to diarrhea. These measures, together with training providers, could substantially reduce diarrhea mortalit y and decrease hospitalizations of children by 100 000 per year in the next 5 years.