[Management of acute infantile diarrhoea: a study on community pharmacy counseling in the Midi-Pyrenees region].
Counselling by community pharmacists is becoming an accepted standard for pharmacy practice. However, drugs available in children without prescription form are scarce, and most of the over-the-counter drugs have not been tested and approved in children.


OBJECTIVE
The aim of this study was to investigate attitude and knowledge of community pharmacists about advice and treatment in children with acute diarrhoea.


METHODS
We sent a postal questionnaire to a sample of 176 community pharmacies in the Midi-Pyrénées area (South western France), asking what they would give as advice and/or drugs in a simulated case of acute diarrhoea in an eight-month-old baby. For each question (interview of the mother, counselling about hygiene and dietetics, monitoring and drugs), we compared pharmacists answers to available evidence-based data and/or guidelines in the literature and to Summary Products Characteristics (SPC) for each reported drug. Forty one percent of pharmacies answered, giving 101 exploitable questionnaires.


RESULTS
Only 48.5% of subjects have recommended a rehydration solution. 71.3% recommended an inadequate beverage (soda) and 40% recommended stopping food intake despite WHO guidelines. Most of pharmacists (77%) noticed a drug with an appropriate indication and a paediatric mention in the SPC. However, in 12.9% of cases, drugs were contra-indicated or inadequate (loperamide, nifuroxazide, microorganisms available in capsules).


CONCLUSIONS
Even if an appropriate advice was given by most of the responders, improvements in advice are needed: too many pharmacists recommended anti-diarrhoeal drugs and withholding milk despite evidence about their lack of effectiveness on dehydration prevention. Conversely, rehydration solutions, which have been proved their effectiveness since many years, are not sufficiently proposed.
EA 3696, unité de pharmaco-épidémiologie, service de pharmacologie clinique, faculté de médecine, 37, allée Jules-Guesde, BP 7202, 31073 Toulouse cedex 7, France. lapeyre@cict.fr
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D000208:Acute Disease; D000328:Adult; D000930:Antidiarrheals / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D053198:Child Nutrition Sciences; D003376:Counseling / Q000592:standards*; D003968:Diarrhea, Infantile / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000193:education / Q000592:standards; D005260:Female; D005440:Fluid Therapy; D005602:France; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000193:education*; D004366:Nonprescription Drugs / Q000627:therapeutic use; D018579:Patient Selection; D010594:Pharmacies / Q000592:standards*; D010595:Pharmacists / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D024382:Professional Role; D015532:Rehydration Solutions / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014944:World Health Organization
D000930:Antidiarrheals; D004366:Nonprescription Drugs; D015532:Rehydration Solutions