Anticholinergic treatment for sialorrhea in children: A systematic review

Peng You; Julie Strychowsky; Karan Gandhi; Breanna A Chen

doi:10.1093/pch/pxab051

Anticholinergic treatment for sialorrhea in children: A systematic review

Paediatr Child Health. 2021 Aug 27;27(2):82-87. doi: 10.1093/pch/pxab051. eCollection 2022 May.

Authors

Peng You¹, Julie Strychowsky¹, Karan Gandhi², Breanna A Chen^{3

4}

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³ Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
⁴ Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.

Abstract

Background: Sialorrhea in children can be associated with adverse physical and social effects. Treatment using anticholinergic medications has been shown to offer symptomatic relief, but there is no consensus regarding which treatment is the most efficacious.

Objective: To examine the effectiveness of anticholinergic medications for sialorrhea in children.

Methods: A systematic review was carried out in Medline, EMBASE, Cochrane, Scopus, and the Web of Science from inception until April 29, 2020. Studies reporting original data on the efficacy of anticholinergic medications in the management of sialorrhea in children aged 0 to 17 years of age were included. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Data on study design, setting, population, pharmacologic intervention(s), comparator(s), outcomes, and results were extracted and summarized.

Results: The search strategy identified 2,800 studies of which 27 articles were included in the synthesis, including five randomized controlled trials. Each anticholinergic undergoing experimental study (glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine) showed evidence of efficacy. Adverse side effects were common. Significant heterogeneity exists in the studies' methodology and the variability of outcome measures used between studies precluded a meta-analysis.

Conclusions: Glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine have all shown efficacy in the treatment of sialorrhea in children. The small number of reports and the variability in study design precluded a meta-analysis. More studies are needed with uniformity in outcome measures to help guide evidence-based decision making. A guidance table is presented.

Keywords: Anticholinergic; Children; Drooling; Paediatric; Sialorrhea; Treatment.