Background: Medical officers posted in emergency are taught the internationally accepted approach to management of acute diarrhoea, e.g adequate fluid and electrolyte replacement is the fundamental management of acute diarrhoea. Antibiotics should be restricted to specific indications, such as acute dysentery. Despite the well known rationale, there has been a high rate of prescription of antibiotics for acute diarrhoea presenting to Emergency. This study investigates the diarrhoea seasonality and potential opportunities for future diarrhoea control and prevention of patients with acute diarrhoea. Methods: Data collection of pre and post intervention in the following way. All Emergency case records were routinely scrutinized in the Emergency after discharge with the exception of cases that were admitted to the wards. All cases with a discharge diagnosis fitting the clinical criteria of acute diarrhoeal syndrome: diarrhoea, gastroenteritis, dysentery and cholera were separated, analysed and recorded sequentially. Results: In initial period (no intervention) doctors were prescribing antibiotics for 51.4% of case of non-bloody diarrhoea. In the Second intervention period there were few cases, but it is remarkable how few were prescribed antibiotic (19%) while the survey of prescribing habits was underway. In the Third intervention period when an education event took place, it was the peak of the diarrhoea season. Prescribing increased somewhat to 28.2%. In the Forth intervention a letter was sent out to the doctors describing the results so far, and pointing out the lower prescribing by “senior doctors”. The overall changes in prescribing behaviour after the educational interventions were statistically significant. The reduction in prescribing noted when comparing intervention 1 and intervention 4, is highly significant (antibiotic p < 0.001, anti-protozoal p<0.001). In the Fifth intervention period when appropriate prescribing was no longer actively promoted, the rate of prescribing increased again to 40.8% of cases. A similar pattern is noted for antiprotozoal prescribing. The increase in prescribing noted in the Fifth period was still less than in the First period (antibiotic p=0.041, anti-protozoal p=0.055). The increase in prescribing from periods Forth to Fifth was significant. (Antibiotics p<0.001, anti-protozoal p = 0.012).
