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Indian Pediatr 2011;48:
811-812 |
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Prescribing Practices of Doctors in Management
of Acute Diarrhea |
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S Chakraborti, KL Barik, AK Singh and SS NAG
Department of Paediatrics, Burdwan Medical College,
Burdwan, West Bengal, India.
Email:
[email protected]
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We conducted this study to determine the prescribing practices of
doctors in management of acute diarrhea in children in the age group
of 6 month -5 year. Antimotility agents and low/zero lactose formula
was prescibed in 9.8% and 24.7% cases, respectively by general
practitioners.In about 66.6% and 5.7% cases pre/probiotics were
prescribed and oral rehydration salt (ORS) were not prescribed by the
pediatricians.
Key words: Diarrhea, India, management, Practices.
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D
iarrhea is a leading cause of mortality and
morbidity in children, especially in the developing countries, and 19% of
the child deaths are attributable to diarrhea [1]. The Sample Registration
Survey reported that about 10 per cent of infants and 14 per cent of
0-4-year children die due to diarrhea in India [2]. Most of the childhood
acute diarrhea are caused by viral infections and are self limiting in
nature, hence antibiotics should be used in selective cases [3]. The
Indian Academy of Pediatrics recommends use of oral rehydration salt
solution (ORS) in all type of diarrhea along with oral zinc. There is
insufficient evidence to recommend probiotics, antimotility and
antisecretory drugs like racecadrotil, which may even be harmful [4-6].
600 children (6 month-5year old) suffering from acute
diarrhea without dysentery, severe malnutrition or any systemic illness,
attending Pediatric outpatient department of our institute between October
2009 to September 2010 were selected. Out of 600, 480 had consulted at
least once for this episode of diarrhea. Out of these 480, 92 had visited
unqualified practioners so they were excluded from the study. Out of
remaining 388; 214 and 174 had consulted a general practitioner (GP)
(having MBBS degree), and Pediatrician (having MD, DCH, DNB degree),
respectively.
Prescribing rate of antibiotics was as high as 88.7%
and 74.7% among GPs and Pediatricians respectively. Some even used
injectible antibiotics. Co-trimoxzole and metronidazole were the preferred
choices. Pediatricians also prescribed pre/probiotics in 66.6% of cases.
9.8% of GPs prescribed antimotility agents. No ORS was prescribed in
13.1% and 5.7% of patients by GPs and pediatricians, respectively. Oral
zinc was prescribed in about 50% cases. The results are summarized in
Table I.
TABLE I Pattern of Drug Prescription By Doctors in Diarrhea
| Drug |
Pediatricians (n=174) |
General physicians (n=214) |
Total (n=388) |
| Antibiotics |
130 (74.7%) |
190 (88.7%) |
320 (82.5%) |
| Oral |
128 (73.5%) |
180 (84%) |
308 (79.4%) |
| Pro/prebiotics |
116 (66.6%) |
103 (48.1%) |
219 (56.4%) |
| Antiemetics |
63 (36.2%) |
104 (48.6%) |
167 (43%) |
| Antisecretory agents |
39 (22.4%) |
49 (22%) |
88 (22.7%) |
| Antimotility agents |
01 (0.5%) |
21 (9.8%) |
22 (5.7%) |
| Low/zero lactose formula |
26 (14.9%) |
53 (24.7%) |
80 (20.6%) |
| No ORS |
10 (5.7%) |
28 (13.1%) |
38 (9.8%) |
| Oral Zinc |
103 (59.1%) |
89 (41.5%) |
192 (49.5%) |
In a UNICEF survey of 10 Indian districts, not more
than 47% of prescriptions for diarrhea included ORS while "tonics", anti-diarrheal
drugs and injections continued to be prescribed in the same proportion as
for ORS. The survey documented less than 1% prescriptions for zinc [7]. A
retrospective study in tertiary care hospital of Chennai, India showed
that use of antimicrobials and zinc was 41.8% and 65%, respectively. The
use of zinc had increased to 75% over a three year period. This was
accompanied by a decline in the use of antibiotics to below 30% [8]. A
recent hospital based cross-sectional quantitative study from Ujjain,
India, depicted that ORS, antimicrobials, probiotics and racecadrotil was
used in 58%, 71%, 68% and 19% of cases, respectively [9], in present study
it was 90.2%, 82.5%, 56.4% and 22.7%, respectively.
References
1. Cynthia BP, Lana V, Kenji S. Estimating child
mortality due to diarrhea in developing countries. Bull WHO. 2008;86:9.
2. Report on Causes of Death: 2001-03, Office of
Registrar General, India.
3. Parashar UD, Hummelman EG, Bresee JS, Miller MA,
Glass RI. Global illness and deaths caused by rotavirus disease in
children. Emerg Infect Dis. 2003;9:565-72.
4. IAP-UNICEF Guideline on management of acute
diarrhea. Mumbai: Indian Academy of Pediatrics; 2006.
5. Bhan MK, Bhatnagar S. Racecadrotil-Is there enough
evidence to recommend it for treatment of acute diarrhea? Indian Pediatr.
2004;41:1203-4.
6. Bhatnagar S, Bhandari N, Mouli UC, Bhan MK.
Consensus Statement of IAP National Task Force: Status Report on
Management of Acute Diarrhea. Indian Pediatr. 2004;41:335-48.
7. Management Practices for Childhood Diarrhea in
India. Survey of 10 districts. New Delhi: UNICEF; 2009.
8. Balasubramanian S, Ganesh R. Prescribing pattern of
zinc and antimicrobials in acute diarrhea. Indian Pediatr. 2008; 45:701.
9. Pathak D, Pathk A, Marrone G, Diwan V, Lundborg CS.
Adherence to treatment guidelines for acute diarrhoea in children up to 12
years in Ujjain, India - a cross sectional prescription analysis. BMC
Infect Dis. 2011, 11:32.
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