[Improvement in the management of acute diarrhoea in France?].
The management of acute diarrhoea in France improved during the last ten years, with a large increase of oral rehydration solution (ORS) prescription in infants. Severity assessment is too often based on an uncertain evaluation of weight loss instead of a clinical determination. Telephone triage is not accurate without use of protocols and decision-making guidelines. Laboratory tests are rare in ambulatory management but still too frequent in hospital management of children with oral rehydration. ORS prescription of general practitioners regularly increased: 16% in 1988, 29% in 1996, 39% in 2001; and 71% in 2005 (after their reimbursement). The quality of oral rehydration advice remains insufficient. Intravenous rehydration on admission remains still too frequent. Drugs prescriptions include 2 or 3 drugs, with a decrease of loperamide and antibiotics, and an increase of racecadotril (81%). Lactose-free milk prescriptions in infants dropped from 46% in 1996 to 16% in 2005. Isolation and disinfection procedures are insufficient. Rotavirus nosocomial infections incidence is high: 1,6 to 6,3/1000 children less than 5 years of age, contributing to high direct costs.
Martinot
A
A
Pédiatrie générale, urgences et maladies infectieuses, Clinique de Pédiatrie et Pôle de l'Urgence, CHRU de Lille, Hôpital Jeanne de Flandre, av E. Avinée, 59037 Lille cedex, France. amartinot@chru-lille.fr
Pruvost
I
I
Aurel
M
M
Hue
V
V
Dubos
F
F
D000208:Acute Disease; D000930:Antidiarrheals / Q000627:therapeutic use; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis / Q000628:therapy*; D003968:Diarrhea, Infantile / Q000175:diagnosis / Q000628:therapy*; D005440:Fluid Therapy; D005602:France; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015532:Rehydration Solutions / Q000627:therapeutic use
D000930:Antidiarrheals; D015532:Rehydration Solutions