Thursday, 17 January 2013

Chinese doctors prescribe antibiotics instead of rehydration treatments for diarrhoea

Most patients with diarrhoea were given inappropriate antibiotics when they should have received oral rehydration solution
by Michael Woodhead
In Chinese hospitals, patients presenting with diarrhoea are given inappropriate antibiotics and IV infusions rather than the simple oral rehydration therapies recommended in 'best practice' guidelines, and mismanagement  is much worse in rural areas, a study has found.
Researchers from the Department of Infectious Diseases at Peking University First Hospital assessed adherence by tertiary hospital physicians to national guidelines and World Gastroenterology Organization guidelines for the management of acute diarrhea in adults. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Their survey was carried out among physicians and 800 patients in 20 hospitals in Beijing and Shaanxi. Data were collected for 800 patients.
The researchers found that 31% of patients with diarrhoea self-medicated before visiting the clinic, most commonly with antibiotics. The mean interval between the onset of acute
diarrhoea and going to a specialist hospital diarrhea clinic was 2.4 days.
In hospital, routine stool examinations were ordered for 70% of patients, vibrio cholera stool culture for 57%, and non-vibrio bacteria stool culture for only 11%.
Only 62% of patients received the recommended fluid and electrolyte therapy and only 28% received oral rehydration solution. In contrast, 33% of patients were given IV fluids even though only 14% needed it.
Antibiotics were the most common drugs (61%) used and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. In total 51% of patients received irrational antibiotic treatment (unnecessary for 48%; indicated but not prescribed for 3%).
Poor adherence to best practice guidelines was more common in Shaanxi compared with Beijing -  fewer individuals received oral rehydration (8% vs 49% respectively) and more received intravenous fluids (46% vs 21%, respectively). More of the patients in Shaanxi province were given antibiotics (65% vs 57%, respectively), and more received IV antibiotics than Beijing (49% vs 27%).
The researchers conclude: "tertiary hospital physicians in China do not adhere well to [international] guidelines or to national guidelines for the management of acute diarrhea. These findings suggest that nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Source: BMC Public Health

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