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Objective To evaluate the daily practice of pediatricians, physician-perceived reasons for unsatisfactory effects of treatment, and unmet needs in the management of acute pain and/or fever. Methods This was a multinational (n=13), multicenter, non interventional, cross-sectional study conducted in Latin America, Africa, and the Middle East in children under 16 years of age with fever (defined as a central body temperature ≥38°C) and/or acute pain (defined as pain lasting ≤6 weeks). Data were collected during a single visit using a structured physician-administered questionnaire and case report forms. Results A total of 2125 patients were recruited by 178 physicians between September 2010 and September 2011. From the 2117 analyzed patients, 1856 (87.7%) had fever, 705 (33.3%) had acute pain, and 446 (21.1%) had both. Of 1843 analyzed patients with fever, 1516 (82.3%) were previously prescribed a pharmacological treatment for the management of fever concomitantly with a non pharmacological approach, while 1817/1856 patients (97.9%) were currently receiving a prescribed pharmacological treatment for fever. Paracetamol/acetaminophen was the most commonly prescribed antipyretic medication during both previous (70.8%) and current (64.1%) consultations. With regard to acute pain management, 67.2% of the patients received previous and 93.9% received current treatment for pain. The most frequently prescribed analgesic during previous consultations was paracetamol/acetaminophen (53.7%), and the current most commonly prescribed analgesics were non steroidal anti-inflammatory drugs (55.2%). Treatment patterns for patients with both fever and acute pain were similar. Overall, 53.4% of the physicians reported poor treatment compliance as a reason for the unsatisfactory effect of the pain/fever treatment, and the most common unmet need was the availability of new drugs (according to 63.5% of the physicians). Conclusions Adequate management of fever was observed; however, due to the complex etiology of pediatric pain, better evaluation and management of pain in pediatrics is necessary.

Background: Acute diarrhea is a major cause of morbidity and mortality in children, particularly in developing countries (the second cause of death). Probiotics and symbiotics are recent treatments for this disease, especially in the acute phase. Our objective is to compare probiotic or symbiotic treatment against placebo in acute diarrhea by following the evolution of diarrhea in terms of hours, number of bowel movements, volume of stools and their consistency. On a larger scale, we want to find a cost-effective intervention that reduces the morbidity and mortality of diarrhea. Methods: Eighty-three children aged 6 months to 5 years, from three different regions of Mount Lebanon, were randomized to receive a probiotic, a symbiotic or a placebo once daily for 5 days. Patients were excluded from the study if they had any history of a chronic disease. The statistical analysis was carried out on SPSS v22.00 Results: Out of 120 surveys distributed to parents, 84 were completed: 43 patients received probiotics (nine received Lactobacillus, 21 received spores, and 13 patients received yeast), 24 received symbiotics and 17 were controls. Stool consistency normalized on day 4 in the probiotics and symbiotics groups (P = 0.009). Less number of days with fever (P = 0.018) were observed in the probiotic and symbiotic groups (1 day) compared to placebo (4 days). No difference in the symptoms associated with diarrhea was observed in the different groups. Conclusions: Probiotics and symbiotics normalized stool consistency in pediatric diarrhea by day 4 and decreased the number of days with fever compared to control. Our study did not show a statistically significant difference between the different probiotics and symbiotics for the treatment of diarrhea.