title: Hospital Based Prospective Observational Study to Audit the Prescription Practices and Outcomes of Paediatric Patients (6 months to 5 years age group) Presenting with Acute Diarrhea.
abstract: BACKGROUND
  Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons.
  
  
  OBJECTIVE
  To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome.
  
  
  METHODS
  This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome.
  
  
  RESULTS
  In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery.
  
  
  CONCLUSIONS
  In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery.
authors.affiliation: Postgraduate Resident, Department of Pediatrics, T.N Medical College & Nair Hospital , Mumbai, India .
authors.forename: Tapobrata
authors.initials: T
authors.lastname: De
authors.affiliation: Associate Professor, Department of Pediatrics, T.N Medical College & Nair Hospital , Mumbai, India .
authors.forename: Santosh
authors.initials: S
authors.lastname: Kondekar
authors.affiliation: Professor, Department of Pediatrics, T.N Medical College & Nair Hospital , Mumbai, India .
authors.forename: Surbhi
authors.initials: S
authors.lastname: Rathi
keywords: Gastroenteritis; Oral rehydration solution; Probiotics; Racecadotril; WHO