Document Type : Original Article
Authors
- Shahla Rahbar 1
- Seyyed Ali Mozaffarpur 2
- Mohammadreza Esmaeili 3
- Hoda Shirafkan 4
- Mohammad Kamalinejad 5
- Roghayeh Aghalari 6
- Mohsen Mohammadi 3
- Sanaz Mehrabani 3
1 Student Research Committee, Babol University of Medical Sciences, Babol, Iran
2 Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
3 Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
4 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
5 Department of Pharmacognosy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6 The Clinical Research Development Unit of Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, Iran
Abstract
Background: Diarrhea is a leading cause of death in infans and children. This study aimed to evaluate the efficacy of rhubarb syrup in improving acute diarrhea in children.
Methods: This double-blind clinical trial was conducted on 1-6-year-old children with acute viral diarrhea referred to Amirkola Children’s Hospital, Babol, Iran, from October 2021 to October 2022. Children were randomly divided into two groups- the intervention group (rhubarb syrup) and the placebo group- and were treated and followed up for 2 weeks. The primary outcome was the number of loose stools, and the secondary outcome was the length of hospital stay and recovery from acute diarrhea. Intention-to-treat (ITT), log-rank tests, and generalized estimating equation (GEE) were used to analyze the data. A significant level of P < 0.05 was set for the present study.
Results: Totally, 96 children were included in the study (two groups of 48 individuals). After the intervention, no statistically significant difference was found in mean diarrhea frequency between the two study groups (P = 0.809; CI = 0.752-1.895), but the mean frequency of diarrhea at discharge was significantly lower in both groups than at the beginning of the hospital stay (P < 001). Statistically, no significant difference was observed between the study groups in the duration of recovery from the start of treatment (P = 0.296; CI = 2.71-3.28) and the number of hospitalization days (P = 0.193). Three cases of gastrointestinal complications occurred in the rhubarb syrup group and one case of skin complications occurred in the placebo group, which was not statistically significant (P = 0.242; P = 1.0, respectively).
Conclusion: The results of the study show that rhubarb syrup has no significant effect on the treatment of acute viral diarrhea, despite its minor side effects.
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Main Subjects
- Maqbool A, Liacouras C. NELSON Text Book Pediatrics, Major Symptoms and Sign of Digesive Tract Disorders. 2020. p. 7563-90.
- Phan TG, Nishimura S, Okame M, Nguyen TA, Khamrin P, Okitsu S, et al. Virus diversity and an outbreak of group C rotavirus among infants and children with diarrhea in Maizuru city, Japan during 2002-2003. J Med Virol. 2004;74(1):173-9. doi: 10.1002/jmv.20162.
- Davidson G, Barnes G, Bass D, Cohen M, Fasano A, Fontaine O, et al. Infectious diarrhea in children: working group report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2002;35 Suppl 2:S143-50. doi: 10.1097/00005176- 200208002-00012.
- Dalgic N, Sancar M, Bayraktar B, Pullu M, Hasim O. Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: are they effective? Pediatr Int. 2011;53(5):677-82. doi: 10.1111/j.1442-200X.2011.03325.x.
- Kotloff KL. Acute Gastroenteritis in children. In: Nelson Text Book Pediatrics. Elsevier; 2020. p. 7997-8054.
- Capinera JL. Introduction. In: Capinera JL, ed. Handbook of Vegetable Pests. 2nd ed. Academic Press; 2020. p. 1-21.
- Khiveh A, Hashempur MH, Shakiba M, Lotfi MH, Shakeri A, Kazemeini S, et al. Effects of rhubarb (Rheum ribes ) syrup on dysenteric diarrhea in children: a randomized, double-blind, placebo-controlled trial. J Integr Med. 2017;15(5):365-72. doi: 10.1016/s2095-4964(17)60344-3.
- Lai F, Zhang Y, Xie DP, Mai ST, Weng YN, Du JD, et al. A systematic review of rhubarb (a traditional Chinese medicine) used for the treatment of experimental sepsis. Evid Based Complement Alternat Med. 2015;2015:131283. doi: 10.1155/2015/131283.
- Behdasht Government of Iran. MANA Guideline. Available from: https://phc.umsu.ac.ir/uploads/dasturmana.pdf.
- Mehrabani S, Esmaeili M, Moslemi L, Tarahomi R. Effects of lactose-restricted regimen in breastfeeding children with acute diarrhea. Int J Prev Med. 2020;11:75. doi: 10.4103/ijpvm. IJPVM_80_19.
- Letuka P, Letlotlo J. Microbial Profiling of Street Vended Foods and the Assessment of Food Handler Kaps in Maseru, Lesotho. Bloemfontein: Central University of Technology, Free State; 2019.
- Johnston BC, Shamseer L, da Costa BR, Tsuyuki RT, Vohra S. Measurement issues in trials of pediatric acute diarrheal diseases: a systematic review. Pediatrics. 2010;126(1):e222- 31. doi: 10.1542/peds.2009-3667.
- Dinleyici EC, Martínez-Martínez D, Kara A, Karbuz A, Dalgic N, Metin O, et al. Time series analysis of the microbiota of children suffering from acute infectious diarrhea and their recovery after treatment. Front Microbiol. 2018;9:1230. doi: 10.3389/fmicb.2018.01230.
- Salehi A, Shariatifar N, Salehi A, Mohammadzadeh A. In-vitro antimicrobial effect of aqueous and alcoholic extracts of Rheum ribes on some food-borne pathogens. J Sabzevar Univ Med Sci. 2016;23(3):430-7. doi: 10.21859/sums-2303430. [Persian].
- Kosikowska U, Smolarz H, Malm A. Antimicrobial activity and total content of polyphenols of Rheum L. species growing in Poland. Cent Eur J Biol. 2010;5(6):814-20. doi: 10.2478/ s11535-010-0067-4.
- Kazemi Darsanaki R, Parsa Lisar M. Antimicrobial potential of root, stalk and leaves extracts of Rheum ribes. J Rep Pharm Sci. 2014;3(1):10-3. doi: 10.4103/2322-1232.222542.
- Fazly Bazzaz BS, Khajehkaramadin M, Shokooheizadeh HR. In vitro antibacterial activity of Rheum ribes extract obtained from various plant parts against clinical isolates of gram-negative pathogens. Iran J Pharm Res. 2005;4(2):87-91. doi: 10.22037/ijpr.2010.621.
- Qin Y, Wang JB, Kong WJ, Zhao YL, Yang HY, Dai CM, et al. The diarrhoeogenic and antidiarrhoeal bidirectional effects of rhubarb and its potential mechanism. J Ethnopharmacol. 2011;133(3):1096-102. doi: 10.1016/j.jep.2010.11.041.