Oral rehydration therapy (ORT) &

Low-osmolarity oral rehydration solution (ORS)

Featured resources

Clinical management of acute diarrhoea (2004)
World Health Organization (WHO), UNICEF
This official joint statement updates previous WHO/UNICEF recommendations on the management of acute diarrhea, taking into consideration new research findings that indicate the success of interventions incorporating reduced-osmolarity ORS and zinc supplementation.

Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers (2005)
US Agency for International Development (USAID) Micronutrient Program
These guidelines were developed to advise clinic-based health workers on implementing the latest WHO/UNICEF recommendations for ORS and zinc supplementation in the clinical management of diarrhoea.

Guidelines for new diarrhea treatment protocols for community-based healthcare workers (2005)
USAID Micronutrient Program
These guidelines were developed to advise community health care workers who assist parents with home treatment of children with diarrhea with regard to the latest WHO/UNICEF recommendations.

Implementing the new recommendations on the clinical management of diarrhoea - guidelines for policy makers and programme managers (2006)
WHO
This manual advises policy makers and program managers on implementing and/or scaling up use of the new ORS formulation and zinc supplementation for the clinical management of diarrheal disease, as recommended by WHO and UNICEF.

Rehydration Project (2006)
This website provides up-to-date and comprehensive information and links to resources on diarrhea, dehydration, oral rehydration, breastfeeding, and related topics.

A simple solution (2006)
TIME magazine
This news article provides a comprehensive update on the current use of ORS to treat severe diarrhea, as well as other promising interventions, including rotavirus vaccines.

The treatment of diarrhoea: A manual for physicians and other senior health workers (2005)
WHO
Developed for physicians treating infectious diarrhea in young children, this manual has been updated to include guidelines for the use of reduced-osmolarity ORS and zinc supplements.

General information

The evolution of diarrhoeal and acute respiratory disease control at WHO: Achievements 1980–95 in research, development and implementation (1999)
WHO (WHO/CHS/CAH/99.12)
This document summarizes the evolution of WHO’s strategy toward researching and implementing interventions for diarrheal disease and acute respiratory disease control in the developing world, including a focus on current integrated strategies for child health.

Expert consultation on oral rehydration salts (ORS) formulation (2001)
WHO, UNICEF (WHO/FCH/CAH/01.22)
This meeting report provides background information essential to an expert committee’s consensus toward reducing the osmolarity of previous ORS standards.

Improved formula for oral rehydration salts to save children’s lives (2006)
WHO, UNICEF
This press release announces WHO and UNICEF adoption of the new, reduced-osmolarity formulation of ORS and provides links to informative resources from both organizations.

Monograph for oral rehydration salts (2005)
WHO, The International Pharmacopoeia
This updated monograph on the new, low-osmolarity formula of ORS was revised to provide the quality specifications as adopted by the WHO Expert Committee on Specifications for Pharmaceutical Preparations in October 2005. The monograph was prepared for inclusion in the fourth edition of The International Pharmacopoeia, currently in press.

Oral rehydration salts: Production of the new ORS (2006)
WHO, UNICEF (WHO/FCH/CAH/06.1)
Updated in 2006, this manual provides comprehensive information on manufacturing the new formula of low-osmolarity ORS.

Treatment guidelines

Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy (2003)
US Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 52(RR-16):1-16.
This publication provides guidelines for the use of ORS for clinical management of diarrhea, discusses various formulations of ORS, addresses challenges related to the administration of ORS, and encourages the use of ORS in the home to potentially avoid clinic visits and hospitalizations.

Reducing deaths from diarrhea through oral rehydration therapy (2000)
Victora CG, Bryce J, Fontaine O, Monasch R. Bulletin of the World Health Organization. 78(10):1246-1255.
This report evaluates global use of ORS and its impact on reducing diarrheal disease mortality. The authors call for continued and improved data collection regarding the use of ORS and note the benefits such data offer toward informing public health policies and programs.

Treatment of diarrhoeal diseases: Information for pharmacists and other drug sellers (2001)
WHO Department of Child and Adolescent Health and Development
This guide aims to improve the practices of pharmacists and drug sellers by providing details on avoiding inappropriate interventions for diarrhea, including underuse of ORS and overuse of antibiotics.

Research

Clinical trials of improved oral rehydration salt formulations: A review (1994)
Bhan M, Mahalanabis D, Fontaine O, Pierce N. Bulletin of the World Health Organization. 72(6):945–955.
The authors of this review assess the efficacy and use of different formulations of ORS, as determined in previously published studies.

Falling diarrhoea mortality in Northeastern Brazil: Did ORT play a role? (1996)
Victora C, Olinto M, Barros F, Nobre L. Health Policy and Planning. 11(2):132–141.
This study provides data that supports the impact of ORS on dramatic reductions in diarrhea deaths recorded after its introduction in Brazil in the 1980s.

Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico (1996)
Gutierrez G, et al. Bulletin of the World Health Organization.74(2):189–197.
This study evaluates the impact of education, ORS introduction, and sanitation improvements on the incidence of diarrheal disease mortality in Mexico between 1978 and 1993.

Multicentre evaluation of reduced-osmolarity oral rehydration salts solution (abstract only; 1995)
International Study Group on Reduced-osmolarity ORS Solutions. Lancet. 345(8945):282-285.
The investigators in this study compared the efficacy of reduced-osmolarity and standard ORS in children with acute diarrhea in four developing countries and determined that reduced-osmolarity ORS is the more appropriate intervention for children with non-cholera diarrhea.

Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: Systematic review (2001)
Hahn S, Kim Y, Garner P. British Medical Journal; 323:81–85.
Another evaluation of standard versus reduced-osmolarity ORS, this analysis involved data from 15 trials and determined that treatment with reduced-osmolarity solution resulted in decreased stool output and vomiting and reduced the need for intravenous infusions.

Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution (abstract only; 2006)
Alam N, et al. Journal of the American Medical Association. 296:567-573.
Authors of this study evaluated the risk of hyponatremia, or reduced sodium levels in the blood, among infants hospitalized with dehydrating diarrhea and treated with reduced-osmolarity ORS. The investigators found no increased risk for hyponatremia when the new ORS formulation was used to treat the infants' dehydration.