• Fyhn Cormier posted an update 6 days, 16 hours ago

    We planned subgroup analysis based on dosage and treatment duration, however, the number of trials in each stratum was so limited that subgroup analysis could not be conducted as planned.Thus, the impact of different dosages, frequencies and treatment durations on the outcomes was not evaluated.According to available evidence, berberine has a good effect on infectious, noninfectious, acute and persistent diarrhea.It can also be used to treat adults and children with diarrhea.There is also some evidence for the efficacy of berberine Targetmol’s Gossypol,dehydrogenase combined with montmorillonite in the treatment of diarrhea in children.The use of berberine and berberine in combination with montmorillonite appears to be an adjunctive therapy for diarrhea.Although some studies have demonstrated the efficacy of berberine and montmorillonite in combination with anisodamine, vitamin B or probiotics for diarrhea; however, due to the small number of studies and participants, we are not certain of this.Berberine enema treatments for childhood diarrhea were very outstanding.Montmorillonite slows down the peristaltic speed of the intestinal wall, improves the microcirculation of intestinal, and enhances the immunity of body.Vitamin B promotes metabolism, repairs the gastrointestinal mucosa and improves the function of the digestive system.Probiotics adjust the balance of intestinal flora, inhibit the production of endotoxins by harmful bacteria and maintain the normal physiological function of human intestines.Berberine combined with montmorillonite and vitamin B or probiotics can improve dyspepsia, reduce vomiting and restore the normal physiological function of the intestinal mucosal barrier.Because of the low bioavailability of berberine, it needs to be given three times a day for adults.Although it adds extra burden to the patients, it only has a high drug concentration in the intestine, and its blood drug concentration is almost negligible.Thus, berberine can reduce the risk of systemic side effects.Acute diarrhea is often due to viruses or bacteria which are resistant to some antibiotics.Overall, studies included in our review were infectious diarrhea; however, no pathogen was reported.We are unable to tell whether there were misuse of antibiotics.We suggest, in clinical practice, antibiotics should be prescribed according to local regulations to avoid as much as possible misuse and overuse. Merits and risks of berberine enema need to be further explored.Implications for research A large sample and multicenter welldesigned clinical studies on berberine in specific population and treatment protocol are needed since berberine has shown therapeutic evidence or potentials in all above circumstances with seemingly low safety risk, and preclinical research evidence support.Economic analysis should be provided to guide practices in different countries or regions.Berberine alone or combined with montmorillonite may have benefit for diarrhea.There are few studies evaluating necessary outcomes in berberine for diarrhea, especially for absenteeism, the intensity of antibiotic use, quality of life and recurrent diarrhea.Due to the risk of bias and concern of publication bias, the above evidence was moderate to low or very low.All authors approved the final version of the article, including the authorship list.Ending preventable child deaths from pneumonia and diarrhea by. Visit SAGE journals online hometag SAGE journa ls Its high infectivity and moderate mortality have resulted in an urgent need to find an effective treatment modality.

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