Reviewed are all the published clinical trials of
glycine-based
oral rehydration salts (
ORS),
L-alanine-based
ORS,
L-glutamine-based
ORS,
maltodextrin-based
ORS, and rice-based
ORS, as well as the results of several recently completed, but unpublished, studies of these formulations that were supported by WHO. All experimental
ORS formulations contained the same concentrations of
salts as
citrate-based
WHO-ORS; all trials were randomized comparisons with
WHO-ORS, and all except those with rice-based
ORS were double-blind studies. The rate of stool loss and, less frequently, the duration of diarrhoea were used as indicators of clinical performance to compare
ORS formulations. The following conclusions were reached concerning the efficacy and use of modified
ORS formulations. Rice-based
ORS (50 g/l) is superior to
WHO-ORS for patients with
cholera, and for such patients it can be recommended in any situation where its preparation and use are practical. Rice-based (50 g/l) and
WHO-ORS solutions are equally effective for treating children with acute non-
cholera diarrhoea, when feeding is resumed promptly following initial
rehydration, as has been consistently recommended by WHO. Since rice-based
ORS is not superior to
WHO-ORS for such children, there is no apparent reason to advise a change from
glucose to pre-cooked rice in the recommended formulation for
WHO-ORS.
Maltodextrin-based
ORS formulations (50 g/l) and
WHO-ORS appear to be equally effective for treating children with acute non-
cholera diarrhoea; there is no reason to advise a change from
glucose to
maltodextrin in the recommended formulation for
WHO-ORS.
Amino-acid-containing
ORS formulations are not recommended for either non-
cholera or
cholera diarrhoea, since they are more costly and have no clinical advantage over
WHO-ORS for children with acute non-
cholera diarrhoea or over rice-based
ORS for persons with
cholera.