Pre-hospital management of infantile gastroenteritis.

Sir, Recommendations for the treatment of gastroenteritis in children have stressed the importance of oral rehydration solutions and withdrawal of milk feeds for 24 hours in bottle fed infants.' The use of antibiotics should be limited to specific indications such as giardiasis or shigellosis, and antidiarrhoeal agents should be avoided as they are ineffective and may be harmful.2 In view of these recommendations a survey was undertaken to assess the prehospital management of infantile gastroenteritis. Between November 1988 and February 1989 100 patients under the age of two years were admitted to this unit with a primary diagnosis of gastroenteritis. All patients were referred or had been seen by their general practitioners or deputies since the onset of symptoms. Age, sex, duration of symptoms, reason for admission and fluid and drugs prescribed prior to admission were recorded in addition to treatment given on the ward. Therfe were 59 boys and 41 girls with a mean age of 9.2 months (range 0.5-23). The duration of symptoms ranged from 12 hours to 28 days with a mean of 5.9 days. The commonest reasons given for requesting admission were persistent symptoms (70) and dehydration (20); other reasons were pyrexia (two) and poor social circumstances or mother not coping (eight). A total of 80 patients received commercially available oral rehydration solutions, seven were instructed to be given fluids only, and in 13 no change in feeding was advised (Table 1). Of the 16 patients given antibiotics nine had significant symptoms prior to the diarrhoea or vomiting such as cough, pyrexia, febrile fit or possible ear infection for which they were prescribed the drugs. Therefore seven patients received antibiotics primarily for gastroenteritis. The most commonly used antidiarrhoeal was kaolin (10) in addition to loperamide (two), and diphenoxylate (two).