ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand

Howteerakul, Nopporn; Higginbotham, Nick; Freeman, Sonia; Dibley, Michael J.

doi:10.1016/s0277-9536(02)00478-1

Cited by 30 publications

(22 citation statements)

References 22 publications

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“…Studies in Peru and Thailand conducted at hospitals and health facilities, relating to treatment for diarrhoea, note that patient expectations can impact antibiotic prescribing behaviour [20, 21]. However, in exploring factors related to the overuse of antimalarials at hospital level in Tanzania, Chandler et al [22] found that patient satisfaction did not appear to be dependent on prescription of antimalarials.…”

Section: Resultsmentioning

confidence: 99%

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study

Graham

Sinyangwe²,

Nicholas

et al. 2016

BMC Public Health

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BackgroundAntibiotic resistance is an issue of growing global concern. One key strategy to minimise further development of resistance is the rational use of antibiotics, by providers and patients alike. Through integrated community case management (iCCM), children diagnosed with suspected pneumonia are treated with antibiotics; one component of an essential package to reduce child mortality and increase access to health care for remote populations. Through the use of clinical algorithms, supportive supervision and training, iCCM also offers the opportunity to improve the rational use of antibiotics and limit the spread of resistance in resource-poor contexts. This study provides evidence on antibiotic use by community health workers (CHWs) and caregivers to inform iCCM programmes, safeguarding current treatments whilst maximising access to care.Methods1497 CHW consultations were directly observed by non-clinical researchers, with measurement of respiratory rate by CHWs recorded by video. Videos were used to conduct a retrospective reference standard assessment of respiratory rate by experts. Fifty-five caregivers whose children were prescribed a 5-day course of antibiotics for suspected pneumonia were followed up on day six to assess adherence through structured interviews and pill counts. Six focus group discussions and nine in depth interviews were conducted with CHWs and caregivers to supplement quantitative findings.ResultsThe findings indicate that CHWs adhered to treatment guidelines for 92 % of children seen, prescribing treatment corresponding to their assessment. However, only 65 % of antibiotics prescribed were given for children with experts’ confirmed fast breathing pneumonia. Qualitative data indicates that CHWs have a good understanding of pneumonia diagnosis, and although caregivers sometimes applied pressure to receive drugs, CHWs stated that treatment decisions were not influenced. 46 % of caregivers were fully adherent and gave their child the full 5-day course of dispersible amoxicillin. If caregivers who gave treatment for 3 to 5 days were considered, adherence increased to 76 %.ConclusionsCHWs are capable of prescribing treatment corresponding to their assessment of respiratory rate. However, rational use of antibiotics could be strengthened through improved respiratory rate assessment, and better diagnostic tools. Furthermore, a shorter course of dispersible amoxicillin could potentially improve caregiver adherence, reducing risk of resistance and cost.

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Section: Resultsmentioning

confidence: 99%

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study

Graham

Sinyangwe²,

Nicholas

et al. 2016

BMC Public Health

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“…5,6,15,16 For example, some physicians prescribed antibiotics in addition to ORS because of a shortage of time or lack of motivation to explain to other caretakers the benefits of managing diarrhoea without medication, 5,16 and also the need to satisfy caretakers' expectations and protect their own reputation. 6,15,16 It is possible that medical trainees, on the other hand, treat children with acute diarrhoea more appropriately because they are less concerned with such factors. However, in this study, the difference in appropriate use of antibiotics between medical trainees and staff physicians should be interpreted with caution because of the small number of trainees.…”

Section: Discussionmentioning

confidence: 99%

Appropriate use of empirical antibiotics in acute diarrhoea: a cross-sectional survey in southern Thailand

Osatakul

Puetpaiboon

2007

Annals of Tropical Paediatrics

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“…Additionally, antimotility drugs without antibiotics were dispensed at 39 pharmacies (23.78%). Adsorbents and antimotility drugs are known to be dangerous for children under the age of five, and the WHO restricts the use of antimotility drugs for children, since fatalities have been reported [9,23]. Probiotics are expensive to purchase, and there is limited evidence of their effectiveness in treating childhood diarrhea [24].…”

Section: Antimotility and Probiotic Drugs Usementioning

confidence: 99%

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

Diwan

Sabde

Byström

et al. 2015

J Infect Dev Ctries

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Introduction: In low-and middle-income countries such as India, private pharmacies play an important role in medical treatments, offering advice for common illnesses such as diarrhea and respiratory tract infections. There is a need to explore the details of the dispensing practices at the private pharmacies in low-and middle-income countries. Methodology: The present study used simulated client methodology to assess the actual dispensing practices for patients with pediatric diarrhea at private pharmacies in an urban setting of an Indian province. Results: This study identified 164 private pharmacies (84.10%) in the study setting that engaged in the practice of dispensing prescription drugs without prescriptions. Only about 40% asked clients if they had a prescription from a doctor. The average duration of consultations at the pharmacies was 1.3 minutes (range, 0.5-6 minutes). The dispensing of drugs was not in compliance with the recommended guidelines and regulations. The most commonly dispensed drugs were antibiotics (40.24%); of these, quinolones either alone or in combination with imidazoles were the most frequently dispensed. The other commonly dispensed drugs were antimotility drugs (31.10%) and Lactobacillus acidophilus (probiotics; 23.17%). The drugs were dispensed in inappropriate doses due to the absence of indications. Conclusions: Overuse and misuse of all these prescription drugs dispensed by pharmacies pose significant issues, such as resistance, dangerous side effects, and high costs. At the same time, the pharmacies did not dispense recommended drugs such as oral rehydration solution and zinc, which they are authorized to dispense without a prescription.

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ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand

Cited by 30 publications

References 22 publications

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study

Appropriate use of empirical antibiotics in acute diarrhoea: a cross-sectional survey in southern Thailand

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

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