[Evaluation of the ambulatory treatment of acute diarrhea in infants. Réseau interhospitalier d'evaluation des pratigues médicales dans les affections courantes de l'enfant].
BACKGROUND
Gastroenteritis remains a common and expensive illness. Oral rehydration solutions (ORS) have been shown to be effective in the prevention and treatment of dehydration, the prime cause for diarrhea-related morbidity and mortality.


OBJECTIVE
To evaluate the ambulatory management of acute gastroenteritis in infants, and particularly practices concerning oral fluid therapy.


METHODS
This prospective, multicenter study included 326 infants (mean age: 10 +/- 6 months), examined in a hospital for acute gastroenteritis, with or without dehydration.


RESULTS
Before admission, 81% had previously been examined by a practitioner, and 89% of these practitioners had written a prescription. This prescription included ORS in 35% and was not different according to the age of the infant. Pediatricians prescribed ORS more frequently than general practitioners (respectively 58% vs 29%; P < 0.001). The failure rate of ORS prescription was 25% (two parents did not observe, ten children refused to drink, and eight stopped treatment because of vomiting). Lactose-free milks were prescribed in 46% of infants and the observance was 82%. At least one drug was prescribed in 94% of infants, with a mean of 2.6 drugs per infant; one antibiotic was prescribed in 33% of infants. Infants were admitted to hospital without any previous consultation in 18%, on the parents' initiative but after at least one previous medical examination in 52%, and on the physician's initiative in 30%. Thirty-three percent were dehydrated; one infant died and two had sequellae.


CONCLUSIONS
The use of ORS remains insufficient. Efforts to improve use of ORS should be expanded beyond physician education.
Martinot
A
A
Service de réanimation pédiatrique, hôpital Jeanne-de-Flandre, Lille, France.
Dumonceaux
A
A
Grandbastien
B
B
Hue
V
V
Leclerc
F
F
D000208:Acute Disease; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000704:Analysis of Variance; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000628:therapy*; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D011446:Prospective Studies