The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.
PIP: Treatments of diarrhea in children under 5 by the Hospital Infantil de Mexico (Federico Gomez), Mexico City, in 1983-84 versus 1986 were compared with respect to drugs and laboratory tests, and costs were estimated. An outpatient oral rehydration unit was opened in the emergency room, reducing by 25% numbers of inpatients with diarrhea. Other than increased use of ORS, no changes in hospitalized patients were evident except a trend toward more laboratory tests, and prescription of amoxicillin and chloramphenicol over amikacin. There was little evidence that laboratory tests or antibiotic prescriptions were appropriate in most cases. Only 1 patient had a positive Shigella culture, and those with negative fecal cultures received more antibiotics than those with no cultures taken. Intravenous solutions were used in 85%, while only 17% were dehydrated and 22% had electrolyte imbalances, possibly because as a method of rehydration they require less nursing time than oral solutions. The average patient costs were 1200 pesos for lab tests and 180 pesos for drugs. In addition, prior to hospitalization, many patients had received ineffective or dangerous drugs such as Kaopectate-antibiotic mixtures, intestinal motility agents such as loperamide, Lactobacillus cultures, and iodochlorohydroxyquinoline.