THERMOPHILIC AMYLASE-DIGESTED RICE-ELECTROLYTE SOLUTION IN THE TREATMENT OF ACUTE DIARRHEA IN CHILDREN

Objective. To compare the efficacy of an oral rehydration solution (OR S) containing short polymers of glucose derived from rice (Amylyte-ORS ) and five times the caloric density of current ORS to the standard gl ucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children. Methods. The rice ORS (Amylyte-ORS) was ob tained by adding thermophilic amylase (252 500 MW units) and salts (1. 5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mt water. This yields 250 mL Amylyte-ORS, which cont ains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO- ORS. One hundred forty-four male children 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydrati on, were assigned by random allocation to receive either WHO-ORS or Am ylyte-ORS. Data from 127 children were analyzed (57 received the WHO-O RS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 give n the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antib iotics during the study. Free water and feeding were allowed after the children were rehydrated. Results. The clinical characteristics of th e children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were tre atment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 +/ - 2.5 vs 34.7 +/- 1.8 hours; P < .03) compared to the WHO-ORS, regardl ess of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 +/- 15.2 vs 295 +/- 17.6 mL/ kg; P < .01) and weight gain was significantly more (367.7 +/- 45.1 vs 199.2 +/- 38.2 g; P < .01) than in those given the WHO-ORS. The net i ntestinal fluid balance and total body fluid balance were similar in t he two groups. Conclusions. Amylyte-ORS efffectively rehydrates childr en with acute diarrhea, reduces diarrhea duration, decreases ORS requi rements, and improves weight gain compared to the WHO-ORS.