Methodological quality of clinical practice guidelines on probiotics in acute gastroenteritis in children using the appraisal of guidelines for research & evaluation II instrument (AGREE II)

Abstract

Introduction: Acute Gastroenteritis (AGE) is one of the diseases that most frequently affects paediatric population. Successful treatment in AGE has been mainly based on prevention and treatment of its complications; every day, we find more publications on the use of adjuvants to decrease its duration. Probiotics have gained greater importance because some of them report benefits. We look for Clinical Practice Guidelines (CPG) that recommend their use in AGE in children. The AGREE II instrument was developed to address the issue of variability in guideline quality, so it is a tool that assesses the methodological rigour and transparency in which a guideline is developed. Aims & Methods: To assess the methodological quality of clinical practice guidelines (CPG) on the use of probiotics in infant diarrhoea. The search was conducted in December 2016, of CPG based on the evidence, the last 10 years and unrestricted language, PubMed, ScienceDirect, and Lilacs. In PubMed, the search terms were: probiotics AND infants; limit: 'guideline'. In ScienceDirect: Probiotics AND infants; limit: Medicine and Dentistry and LILACS: 'probiotics' AND 'infants' and 'probióticos' AND 'guía'.The CPG selected were evaluated with the instrument AGREE II by two evaluators who were independent one from the other and by a third evaluator, when there were discrepancies. The concordance of the evaluations was measured with the index of kappa. Results: Ten documents were recovered only in PubMed, and selected only 03 that fulfilled the criteria about probiotics.The other two were located in a direct way. The 5 CPG were: 1. Diarrhea and vomiting caused by GE - NICE; 2. CPG on the diagnosis and treatment of the AID in Pediatrics - Peru; 3. ESPGHANESPID evidence-based guidelines for the management of AGE in children in Europe. Update (2014); 4. Clinical practice guideline ILA on the management of GEA in children under 5 years and 5. Use of probiotics for management of AGE. A position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. All of the CPG consider that the administration of Lactobacillus rhamnosus GG and Saccharomyces boulardii should be considered in the management of children with AGE as an adjunct to rehydration therapy with different level of evidence. The concordance between evaluators was >0.9 and <1.0 for all guidelines. Four CPG had one rating higher than 60% in 4 or more domains and one in only one domain. Only a CPG was greater than 60% in all domains. Four had an overall score greater than or equal to 5 and were 'recommended', and one with modifications, according to the instrument AGREE II. The CPG 5 is a Position Paper of a Working Group, not a Guideline, and it's the reason for the lower rates obtained. Conclusion: Conclusions: The selected CPG have good methodological quality, but are not specific to probiotics. Despite, they should be spread for better decision making. (Table Presented).