Rice-Based Oral Rehydration Solution Outperforms Glucose-Based Solution For Treating Cholera

A study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health shows that a new pre-packaged rice-based oral rehydration solution (ORS) designed to treat children with cholera and life-threatening diarrheas outperformed similar glucose-based ORS, which is the standard treatment for the disease recommended by the World Health Organization (WHO).

In the randomized study of children living in Bangladesh, children receiving rice-based ORS had 20 percent less stool output within the first eight hours of treatment compared to children given glucose-based ORS. The findings, which appear in the May 2001 issue of Acta Paediatrica, suggest that the new pre-packaged rice-based ORS is a safe and effective treatment for cholera and for other forms of severe acute diarrhea.

"We've been using freshly ground rice in ORS in our hospitals in Bangladesh for some time, but it cannot be conveniently distributed everywhere, because it spoils in a few hours, and it requires expertise to prepare," says David Sack, MD, professor of international health at the Johns Hopkins Bloomberg School of Public Health and director of the International Centre for Diarrohoeal Disease Research in Matlab, Bangladesh (ICDDR, B). "This study shows that the pre-packaged rice-based ORS is safe and effective for treating cholera. In addition, it outperformed the current recommended pre-packaged ORS, especially during the crucial early phase of treatment when fluid losses are the greatest," adds Dr. Sack.

Since its development at the ICDDR, B in the1960s, ORS has been credited with saving the lives of three million children annually throughout the world who suffer from dehydration caused by severe diarrhea. ORS treatment can reduce the need for more complicated and expensive intravenous (IV) fluid replacement, which is not always available in developing countries. For its role in the development of ORS, the ICDDR, B recently received the Gates Award for Global Health, and work continues at the Centre to find ways to improve its effectiveness.

The commonly used solution recommended by the WHO is a mixture of water, glucose, sodium, and potassium salts. This solution helps children recover and retain vital fluids and nutrients. The solution comes in ready-to-use packets, which can be easily mixed with water. Research from the early 1980s suggested that ORS made with ground rice was more effective at replacing lost fluids and reducing symptoms, but an effective ready-to-use package form was previously unavailable.

The Johns Hopkins study examined the efficacy of a new pre-packaged rice-based ORS that is manufactured under the brand name CeraLyte. For the controlled, randomized study, doctors treated 167 boys between the ages 5 to 15 years. All of the boys suffered severe dehydrating diarrhea, with losses equivalent to about 30 percent of their body weight while hospitalized. On average, these boys were admitted 14 hours after their illness began, by which time they had already lost 14 percent of their body weight to dehydration. Half of the group was treated with CeraLyte rice-based ORS, and the other half was treated with glucose-based ORS. Both groups were also given antibiotics, IV fluids, and food. Dr. Sack notes that all of the children recovered, but it is likely that 50 percent of the boys would have died with out treatment.

The results showed that the boys who received the rice-based ORS had 20 percent less stool output within the first eight hours of treatment compared to the children who received the glucose-based ORS. However, stool output was similar after the initial period. The results also showed that serum electrolyte concentrations remained normal for both groups of children.

"Additional studies with CeraLyte may be warranted for other conditions where optimized absorption of an oral rehydration solution is needed. These might include short bowel syndrome, other severe diarrheal diseases, and possibly dengue hemorrhagic fever," adds Dr. Sack."

###

K. Zaman, MBB, PhD, Md. Yunus, MBBS, MSc, A Rahman, MBBS, and H.R. Chowdhury, MBBS, MSc, contributed to the research of this study.

Funding for the study was provided by a grant from the Thrasher Foundation. Cera Products Inc. donated the rice-based ORS used in the study. Dr. Sack is a consultant to Cera Products Inc.