OBJECTIVES:: Diarrhea is a major cause of morbidity and mortality among under- five children in developing countries and consumes reasonable portion of household income. Regular drug utilization studies is essential for auditing of drug use trends in public health facilities for improvement of treatment outcomes and reduction of disease burden.The study assessed diarrheal treatment practices among under-five, and documented information on the level of adherence to standard treatment guideline. METHODS:: The study was a retrospective cross sectional analysis of prescriptions in a randomly selected tertiary teaching hospital. It was carried out between January 2016 and February 2017.A total of 350 randomly selected prescriptions with at least one anti-diarrheal agent were used. Eligible prescriptions for under-five children written in English Language between January 2014 and December 2015 were used for the study. Data was summarized using descriptive statistics. RESULTS:: Of the 350 prescriptions studied, 200 (57.1%) were males and 179 (51.1%) came from the urban areas. The mean age was 1.33 ± 0.92 years. Oral electrolyte agents were the most prescribed 388 (50.1%) followed by vitamins and minerals 200(29.7%) while antibiotics were the least prescribed 32 (4.7%). The most used electrolyte agents were oral rehydration salts 338(50.1%) and Zink 184(25.3%) while ringers lactate was the most prescribed parenteral electrolyte solution 50(7.5%). Dextrose water was the least 25(3.7%). Powders were the most prescribed dosage form 388(50.1%) while suspensions were the least 15(2.2%). Generic prescription was 551(81.8%) against the World Health Organization (WHO) recommendation of 100% generic prescription. The average number of drugs per encounter was 4.4 against the recommended 1.6- 1.8. CONCLUSIONS:: The study suggested irrational anti-diarrhea use of drugs among under- five and non- adherence to standard treatment guideline. It provides baseline data for further studies at improving anti-diarrhea utilization.