Science Articles

Pediatric Use of Enterosorbent Polisorb for Acute Gastrointestinal Diseases

Enterosorption, a promising novel therapy, has effective uses in pediatrics. Enterosorbents can help treat a variety of diseases by binding and excreting various exogenous substances, microorganisms and the toxins they produce, as well as endogenous metabolites from the body. Enterosorbents are pharmaceuticals that have a high sorption capacity and do not disintegrate in the gastrointestinal tract (GIT); they are able to bind exogenous and endogenous substances contained in the chyme; they are released into the GIT cavity through its walls by absorption and adsorption, ion exchange, or complexing.

 Enterosorption is integral to efferent therapy (from the Latin efferens, ‘to remove’), which consists in treatments designed to nullify the effects of toxins of various origins and to eliminate them from the body. Beside enterosorption, efferent therapy methods include hemodialysis, peritoneal dialysis, plasmapheresis, hemosorption, etc.

Here are the key requirements to enterosorbents:

  • no toxicity;

  • no damage to the mucous membranes;

  • an ability to evacuate completely from the intestinal tract;

  • good functional (sorption) capacity;

  • no resulting dysbacteriosis;

  • a convenient dosage form.

Many different enterosorbents, both wood-based and chemically synthesized, are available and used in Russia. Polisorb MP is a domestic silica-based sorbent produced in Chelyabinsk Oblast; it meets all the above requirements and represents the best of enterosorbents.

Polisorb MP is a next-gen enterosorbent based on natural highly dispersed silica; it is capable of multifunctional nonselective sorption and is available as powder of particle size ranging from 5 to 20 nm.

Enterosorbents, including Polisorb MP, are designed to remove toxins of any origin from the body. Polisorb MP binds endogenous and exogenous toxins of various origin, including microorganisms and microbial toxins, antigens, food allergens, medications and poisons, salts of heavy metals, radionucleotides, and alcohol in the GIT lumen to further remove them from the body. Polisorb MP also sorbs some body metabolites, including excess bilirubin, cholesterol and lipid complexes, products of nitrogen metabolism, and medium molecular weight substances that contribute to metabolic toxicosis.

Indications for pediatric use of Polisorb MP 


  • Acute intestinal diseases accompanied by diarrheal syndrome (dysentery, salmonelloses, bacterial food poisoning).

  • Hepatitis of any etiology (viral, toxic, autoimmune).

  • Endogenous and exogenous intoxication of any origin.

  • Allergic reactions (drug and food allergies including angioedema, diathesis, dermatitis, psoriasis, bronchial asthma, obstructive pulmonary disease).

  • Chronic kidney failure. 

Polisorb MP is not absorbed in the intestinal tract and naturally excretes from the body, hence virtually no contraindications for use. With few exceptions, the medication is not allergenic. Like other enterosorbents, Polisorb MP must be used with care when treating exacerbation of peptic ulcer disease and gastrointestinal tract hemorrhage.

Posology and administration


Therapeutic dosage is 100-200 mg / kg of body weight per day. The maximum permissible daily dosage is 330 mg / kg for short-term use. The sorbent is taken only in the form of an aqueous suspension.

To prepare an aqueous suspension, take the required amount of the medication (1 heaping teaspoon contains 1 g, and 1 heaping tablespoon contains 3 g of the powder), add 100 ml of water and stir thoroughly. Take the resulting suspension orally an hour before or 1-2 hours after a meal or intake of other medications.

Dosing Polisorb MP is generally not difficult. For adults, the average therapeutic dose is 3-4 tablespoons per day. For children, consult Table 1 to recalculate the dosage.

A.I. Grekova et al. carried out clinical trials of Polisorb MP in acute intestinal infections (AII) in children at Smolensk State Medical University. 

AII is one of the most common infections. 60% to 65% of all AII cases are registered in children, with a particularly high incidence in toddlers (up to 70%).

Literature review suggests the entirety of medical testing can detect the etiology in 56-80% of all cases; Salmonella, Shigella, Vibrio cholerae cause no more than 10% of intestinal infections in children in developed countries.

Rotavirus infection accounts for 9% to 73% of all AII cases, is diagnosed in 20% to 60% of all children hospitalized for intestinal disorders.

Novel etiopathogenetic medications and better AII therapy become imperative as the etiology and pathogenesis of AII in children change with viral diarrheas becoming more prevalent, whilst bacteria grow resistant to antibiotics, and ever more cases have adverse outcomes due to preexisting conditions.

Pathogenetic therapy of diarrhea-associated AIIs includes:

  • detoxification;

  • correcting fluid and electrolyte imbalance;

  • correcting gastrointestinal motility and secretion disorders;

  • correcting intestinal microflora disorders;

  • reinforcing the mucosal reparation of the large intestine;

  • enterosorption.

In case of an infection, enterosorption constitutes pathogenetic and etiological treatment, since sorbents are capable of both absorbing the endogenous and exogenous pathogenic toxins, and binding bacterial and viral pathogens to remove them from the process. The ability to bind endogenous and exogenous pathogenic toxins contributes significantly to detoxifying the body.

Russia’s pharmaceutical market offers a variety of enterosorbents: activated charcoal, lignins, ion-exchange resins; their clinical effects are diverse, and the organoleptic properties are sometimes unpleasant (hydrolyzed lignin). Solubility varies; often, there is an added fragrance, which might be critical for allergic children and may injure the intestinal mucosa. In light of the above, making novel enterosorbents

that meet the safety requirements, especially for pediatric use, remains a relevant undertaking.

Polisorb MP is a fine silica-based medication that meets all the basic requirements to enterosorbents: it is nontoxic, does not injure the GIT mucous membrane, evacuates easily, has great sorption and organoleptic properties.

The goal hereof was to test Polisorb MP in a clinical setting and to improve pathogenetic AII therapy in diarrhea-affected children.

Materials and methods: 65 pediatric inpatients were examined in 2005-2006 at Smolensk City Hospital No. 1, Unit 5 (Intestinal Infections). The clinical trial used hospital-collected data on intoxication (duration of nausea, emesis, loss of appetite), the severity of clinical manifestations (fever period, abdominal syndrome, duration of diarrhea, abnormal findings in stool contents), and laboratory findings (bacteriological and serological data on pathogen identification).

Children were split into two groups: Group A of 35 children on Polisorb MP administered in addition to conventional background therapy including specific antibacterial or antiviral treatment; Group B of 30 children with no Polisorb MP.


Table 1. Polisorb MP dosage chart

Aged <1 

0.3–1 g per day

Aged 1-2

1–2 g per day

Aged 2-7

2–5 g per day

Aged 7-14

5–7 g per day

Aged >14, adults

7–20 g per day









WOMAN AND CHILD

 Age-wise, children aged 5 or younger were dominant in either group, see Fig. 1. Rotavirus infection was prevalent etiologically in both groups. Group A had 18 rotavirus-affected children (51.4%), Group B had 13 (43.3%), see Fig. 2. Moderate cases were prevalent in both groups, see Fig. 3.

Toxicosis assessment. Disappearance of intoxication symptoms reported on Day 4 in Group A, maximum extinction on Day 1 or 2; intoxication symptoms persisted up to Day 7, maximum extinction on Day 2 to 4 in Group B, see Fig. 4.


Table 2. Course of the disease

Criteria

Group А (n=35)

Group B (n=30)

Duration of fever response

2.8 days

3.2 days

Duration of nausea and vomiting

2.3 days

3.6 days

Duration of abdominal pains

2.5 days

3.8 days

Duration of diarrhea

3.2 days

4.3 days

Abnormal findings in stool contents (invasive diarrhea)


3.14 days


3.8 days

Average period of hospitalization

4.3 days

5.8 days


Course of the abdominal syndrome. The abdominal syndrome alleviated in the study group mainly by Day 3; it persisted up to Day 4 in 25% of Group B patients, see Fig. 5. Stool was formed by Day 3 in most patients in Group A, remained liquid in 3.3% in Group B until Day 8. Abnormal findings in stool contents reported up to Day 5 in Group B; no such findings reported in Group A by the end of Day 2 or 3, see Fig. 6. Course based on the data is shown in Tables 1 and 2.

In two cases of shigellosis in Group A (Shigella flexneri 2a isolated), post-treatment control fecal cultures were negative.

No rotavirus isolated in post-treatment stool tests of the 18 rotavirus-infected children (laboratory-confirmed).

Group B also had 2 cases of Shigella flexneri 2a; post-treatment fecal cultures negative.

5 out of the 13 rotavirus-infected children (laboratory-confirmed) tested positive for rotaviruses after treatment.

Each group had 15 cases of AII that were not laboratory-confirmed.

Adverse reactions and hypersensitivity to the enterosorbent not reported in this study.






Table 3. Laboratory data dynamics


Pathogen

Group A

Group B

Pretreatment pathogen detection

Posttreatment pathogen detection

Pretreatment pathogen detection

Posttreatment pathogen detection

Shigella flexneri 2а

2

0

2

0

Rotavirus

18

0

13

5

Pathogen not detected

15

15



Thus, the collected evidence shows that:

  1. Use of Polisorb MP in AII-affected children is associated with a faster recovery from intoxication symptoms, normalization of stool, and disappearance of abnormal findings compared to Group B.

  2. Therapy delivered to Group A resulted in a better elimination of rotaviral pathogens from the intestines.

  3. Therapeutically, Polisorb shortens the course of infection and allows discharging the patient sooner; the medication is cheaper than the alternatives, hinting at potentially better cost-effectiveness.

  4. Enterosorption with Polisorb MP is recommendable for intoxication and diarrhea-accompanied AII in children.

Allergies and allergy-associated gastrointestinal pathologies are among the prevalent pediatric diseases in Russia and many other countries. Data collected by the Pediatric Department No. 1 in 1990-1997 in Chelyabinsk suggests a 10% incidence of food allergies, and a 32.2% incidence of gastrointestinal pathologies. This is why various therapies and comprehensive treatments of allergies, including those comorbid with gastrointestinal lesions, are of great interest.

Whilst the understanding of these diseases has advanced, and pharmaceutical production is on the rise, deciding upon which medication to use and finding out the minimum required pharmaceutical intervention remains pivotal. Clinical manifestations and outcomes of allergies are diverse, often due to the concentration of biologically active compounds and the severity of intestinal dysbiosis (ID).