Despite pediatric and WHO guidelines, ‘irrational’ antibiotic prescribing for diarrhea persists in India

Despite the World Health Organization (WHO) and the Indian Academy of Pediatrics (IAP) guidelines recommending against the use of antibiotics for acute nonbloody diarrhea, many healthcare providers in India do so, according to a recently published study.

“The main financial reason cited by the doctors in the study quoted is that by not prescribing antibiotics, they fear losing patients to other doctors.”
-Anita Kotwani, PhD, lead author of the study, Department of Pharmacology in the Vallabhbhai Patel Chest Institute at the University of Delhi, Delhi, India.

Key Point: Inappropriate prescribing of antibiotics for nonbloody diarrhea in children persists in India despite recommendations against it. The use of antibiotics has resulted in resistance to those antibiotics and doesn’t help most cases of diarrhea that are viral and self-limiting. It’s important to educate patients and parents/caregivers instead of trying to meet their expectations that they get antibiotics. Guidelines call for dispersible zinc and low osmolarity oral rehydration solutions instead of antibiotics.

Based on exit interviews of patients in clinics in 4 areas of New Delhi, the study found that 43% and 69% of diarrhea patients in public and private clinics, respectively, received at least 1 antibiotic prescription. Pediatricians at private clinics prescribed antibiotics for 51.5% of children younger than 13 with diarrhea; at public clinics, pediatricians prescribed antibiotics for 23% of children with diarrhea. Based on exit interviews, none of these children had bloody diarrhea and none should have been prescribed antibiotics.

The survey demonstrates the “irrational use of antibiotics for acute diarrhea,” the authors of the study said in their paper. The WHO and the IAP recommended against the use of antibiotics for nonbloody diarrhea in 2004, and the IAP did so again in 2006 and in 2009. Instead, low osmolarity oral rehydration solutions, combined with...

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