Peer-reviewed article
Management of Acute Diarrhea in Children after Implementing the Thai Clinical Practice Guideline.
Prachuapthunyachart S, Chongsrisawat V, Jennuvat S, Ngoenmak T, Damrongmanee A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed 210 Thai pediatricians about how they manage acute diarrhea in children after a 2019 clinical practice guideline was released. The researchers found significant differences in practice between general pediatricians and pediatric gastroenterologists, particularly in their use of intravenous fluids, oral rehydration salts, feeding advice, and additional medicines. Many practices did not fully align with the guideline recommendations.
Key points
- Pediatric gastroenterologists used intravenous fluids less often than general pediatricians
- Both groups strongly agreed on continuing breastfeeding (88.1% agreement)
- Gastroenterologists preferred reduced-osmolality oral rehydration salts significantly more than general pediatricians
- Variation existed in use of antibiotics, anti-vomiting medicines, and additional drugs that did not always match guideline recommendations
- Gastroenterologists were more likely to have experience with adjunctive therapies like racecadotril and diosmectite
Limitations
This is a survey of reported practices rather than observation of actual clinical care, so there may be differences between what pediatricians say they do and what they actually do. The study describes current practice variation but does not evaluate whether following the guideline more closely leads to better outcomes for children.
Abstract
Purpose Acute diarrhea in children is a common clinical problem, although practice management can vary. This study evaluates the practice of pediatricians in the management of acute diarrhea in children after implementing the 2019 Thai Clinical Practice Guideline. Methods Online questionnaires were sent to Thai pediatricians (general pediatricians or other pediatric subspecialists [GPs] and pediatric gastroenterologists [PGs]) from November 2022 to April 2023. This online survey collected anonymous demographic data and practice-related data. Results A total of 210 pediatricians (179 GPs and 31 PGs) participated in the survey. PGs administered intravenous fluids less often than GPs (adjusted odds ratio [aOR], 0.12; 95% confidence interval [CI], 0.04-0.38; p<0.001) but added potassium after patients began to urinate more than GPs (aOR, 4.76; 95% CI, 1.85-12.27; p<0.001). PGs preferred to use reduced-osmolality oral rehydration salts (ORS) more than GPs (aOR, 9.81; 95% CI, 2.63-36.60; p<0.001). Both GPs and PGs agreed to continue breastfeeding (88.1%). However, fewer PGs recommended switching to lactose-free formula for formula-fed patients (aOR, 0.36; 95% CI, 0.14-0.92; p=0.04). PGs were more likely to have experiences using adjunctive therapy, such as racecadotril and diosmectite (aOR, 7.86; 95% CI, 1.69-36.52; p=0.009 and aOR, 15.42; 95% CI, 2.90-33.63; p<0.001, consecutively). Domperidone was mostly used for patients with the first vomiting episode (52.4%). Conclusion This survey provides insight into the practices of Thai pediatricians for the management of acute diarrhea in children. Variations in the use of oral antibiotics, antiemetics, adjunctive drugs, electrolyte supplementation, and feeding were observed, which may not align with the guideline.