Management of Acute Diarrhea in Children after Implementing the Thai Clinical Practice Guideline

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.

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.

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%).

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.