Community pharmacists’ knowledge and dispensing recommendations for treatment of acute diarrhoea in Trinidad, West Indies R. KARIM, 1 P. RAMDAHIN, 1 J.R. BOODOO, 1 A. KOCHHAR, 1 L.M. PINTO PEREIRA 2 Ministry of Health, 1 Port of Spain, Department of Paraclinical Sciences, 2 Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, West Indies SUMMARY Using a hypothetical case presentation of a patient with acute diarrhoea, community pharmacists in Trinidad were asked about their knowledge and dispensing recommendations to manage acute diarrhoea. Oral rehydration salts (ORS) were recommended by 86% (79), but more pharmacists would recommend ORS as the first choice therapy alone, for chil- dren (70%) than adults (33%) (p < 0.01). Antimotility agents as a first choice therapy alone or with ORS would be given to more adults (60%) than children (10%) (p < 0.01), and more adults (59%) than children (33%) would receive cotrimox- azole. Pharmacists (93%) would counsel on preparation, storage and treatment schedule for ORS, but not on discon- tinuing (32%) or continuing ORS (4%). Despite 51 phar- macists knowing the WHO guidelines to treat acute diarrhoea, only 23 dispensed in accordance. Educational re-enforcement to manage acute diarrhoea and dispensing practices of medications are necessary for pharmacists who are the first patient contact in Trinidad. Keywords: Acute diarrhoea; pharmacist; practice and knowledge; ORS; continuing pharmacy education Ó 2004 Blackwell Publishing Ltd INTRODUCTION Diarrhoeal disease is a primary cause of childhood mortality and morbidity in developing countries and may be ascribed to lack of information on adequate treatment for the illness. Diarrhoea is one of the leading health problems in the developing world (1) and is most common in children particularly between 6 months and 2 years of age. In 1996, the Pan-American Health Organization (PAHO) reported the number of deaths from diarrhoea, in children under 5 years of age, as nine per hundred thousand (100 000) in Trinidad and Tobago (2). Considered as the passage of at least three stools in 24 h diarrhoea relates to consistency rather than frequency of the stool, and acute diarrhoea is an episode of less than 2 weeks duration. The mortality of acute diarrhoea can be attributed to copious loss of body water and salts, and is prevented by early administration of oral rehydration salts (ORS), the non- proprietary name for a balanced glucose–electrolyte mixture (3). Oral rehydration therapy does not stop diarrhoea, but averts fatal dehydration, restores body function and supports the body’s defence system, which in the majority of cases self- limits the pathology to 2 or 3 days (4). The World Health Organization (WHO) promotes ORS to treat acute diarrhoea, and emphasises this approach for pharmacists in the publica- tion ‘The Treatment of Acute Diarrhoea – Information for Pharmacists’ (3). The Pharmacy Board of Trinidad and Tobago distributed the booklet to all pharmacists in the country, since Trinidadians generally rely on the pharmacist for diarrhoea and other health problems. As student pharmacists, three authors of the study had sought treatment for acute diarrhoea, from the local commu- nity pharmacy. Each received treatment recommendations not in agreement with those recommended by WHO, prompting this survey in community pharmacists. We inves- tigated the knowledge and dispensing practices of community pharmacists in a patient with acute diarrhoea presenting at the pharmacy for medication, and examined if their recommen- dations were consistent with the guidelines of the WHOs Diarrheal Diseases Control Program to treat acute diarrhoea. The Ethics Committee of the Faculty of Medical Sciences approved the study. METHODS There are 220 registered pharmacies in the eight counties in Trinidad, and in each pharmacy a registered pharmacist licensed with the Pharmacy Board of Trinidad and Tobago dispenses medication. By random selection an equal representation of Correspondence to: Lexley M Pinto Pereira, MBBS, MD, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad, West Indies Tel./Fax: 11 868 663 8613 Email: lexleyp@hotmail.com This work was carried out in the Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, West Indies. ª 2004 Blackwell Publishing Ltd Int J Clin Pract, March 2004, 58, 3, 264–267 REGIONAL REVIEW