Evaluation of Antibiotic Prescription and Utilization amongst Hospitalized Children in a Tertiary Facility in Sokoto, North-Western Nigeria
ANTIBIOTIC USE IN ADMITTEC CHILDREN
Background: Antibiotics are the most widely utilized therapeutic agents. Inappropriate use causes increase cost and antibiotic resistance. The World Health Organization recommends assessment of antibiotics use to guide prescribing practices.
Objective: To describe the pattern of antibiotic usage among paediatric inpatients aged > 1 month to 15 years in a tertiary hospital in Sokoto, Nigeria.
Methods: Febrile children were recruited prospectively by systematic random sampling from January to October 2018. Socio-demographics, diagnosis, antibiotics administered were obtained from case notes. The WHO indicators of use of antibiotics were employed for evaluation. Data was analysed with SPSS version 23.
Results: Out of 352 children, 318 (90.3%) received antibiotics; commonest being Ceftriaxone in 155/318 (48.7%), Cefuroxime in 74 (23.2%), and Metronidazole in 29 (9.1%). Average number of antibiotics per patient was 2.3±1.1 with treatment duration of 4.3±1.4days. Antibiotic consumption was 937.2 days of antibiotic therapy/1000 patient days (DOT/PD). Generic name was used in 92.3% while 100% of the drugs were on the essential medicine list. Frequent diagnoses were severe malaria 98/352 (27.8%), respiratory infections 39 (11.1%) and severe malnutrition in 38 (10.8%). Only 6 (1.7%) patients had microbiologic evidence of infection.
Conclusion: Utilization of antibiotics is higher than recommended. There is need for improved diagnostic facilities to avoid antibiotic overuse and its consequences.
Keywords: antibiotics, prescription, utilization, children, inpatients, DOT
1. Waksman SA, Flynn JE. History of the word 'antibiotic'. J Hist Med Allied Sci. 1973;28(3):284-286.
2. Girma S, Sisay M, Mengistu G, Amare F, Edessa D. Antimicrobial Utilization Pattern in Pediatric Patients in Tertiary Care Hospital, Eastern Ethiopia: The Need for Antimicrobial Stewardship. Hosp Pharm. 2018;53(1):44-54.
3. World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators. Geneva, Switzerland: World Health Organization; 1993. http://apps.who.int/medicinedocs/en/d/Js2289e/1993. Accessed Aug 5th 2018.
4. Abdalla SN, Yousef BA. Prescribing patterns of antimicrobials in the Internal Medicine Department of Ibrahim Malik Teaching Hospital in Khartoum, 2016. Pan Afr Med J 2019;34:89. doi:10.11604/pamj.2019.34.89.17023.
5. Jafari HS. Major infectious diseases of children in developing countries: Challenges and opportunities of today and the future. Semin Pediatr Infect Dis. 2004;15(3):121-123.
6. Hill DL, Carr EJ, Rutishauser T, Moncunill G, Campo JJ, Innocentin S, et al. Immune system development varies according to age, location, and anemia in African children. Sci Transl Med. 2020;12(529):9522.
7. Paluck E, Katzenstein D, Frankish CJ, Herbert CP, Milner R, Speert D, et al. Prescribing practices and attitudes toward giving children antibiotics. Can Fam Physician. 2001;47:521-527.
8. Hori H, Watanabe M, Sakurai M. Infectious diseases in African children. Acta Paediatr Jpn. 1993;35(6):553-558.
9. Arason VA, Sigurdsson JA. The problems of antibiotic overuse. Scand J Prim Health Care. 2010;28(2):65-66.
10. CDC Vital signs. Making Health Care Safer Antibiotic Rx in Hospitals: Proceed with Caution. 2014 www.cdc.gov/vitalsigns. Accessed 10/12 /19.
11. Kreitmeyr K, von Both U, Pecar A, Borde JP, Mikolajczyk R, Huebner J. Pediatric antibiotic stewardship: successful interventions to reduce broad- spectrum antibiotic use on general pediatric wards. Infection. 2017;45(4): 493–504.
12. Duke Antimicrobial Stewardship Outreach Network. "You cannot manage what you cannot measure": Understanding nuances in antimicrobial use metrics. Antimicrobial Stewardship News. 2016;4(3):1-5.
13. Ibrahim OM, Polk RE. Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges. Infect Dis Clin North Am 2014; 28(2): 195-214.
14. Egbuchulam N, Anyika E, Soremekun R. Antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a paediatric hospital in Nigeria. J Hosp Adm. 2018;7(4):36-43.
15. Umar L, Isah A, Musa S, Umar B. Prescribing Pattern and Antibiotic Use for Hospitalized Children in a Northern Nigerian Teaching Hospital. Ann Afr Med. 2018;17(1):26-32.
16. Chaw PS, Schlinkmann KM, Raupach-Rosin H, Karch A, Pletz MW, Huebner J, et al. Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study. Antimicrob Resist Infect Control 2018; 7: 82. https://doi.org/10.1186/s13756-018-0380-7. 2018.
17. Moehring RW, Dodds Ashley ES, Ren X, Lokhnygina Y, Baker AW, Jones TM, et al. Denominator Matters in Estimating Antimicrobial Use: A Comparison of Days Present and Patient Days. Infect Control Hosp Epidemiol. 2018;39(5):612-615.
18. Dutta S, Bhattacharjee A, Devi MN. Prescription pattern of antibiotics in paediatric inpatients at a tertiary care hospital in North East India. Int J Basic Clin Pharmacol 2017;6:2384-2387.
19. Laya VR, Modupalli A. Prescribing Pattern of Antibiotics in Pediatric Inpatient Department of a Tertiary Care Teaching Hospital in Bangalore. IOSR JPBS. 2015;10 (4) 26-32 www.iosrjournals.org.
20. Choudhury D, Bezbaruah B. Antibiotic Prescriptions Pattern in Paediatric In-Patient Department Gauhati Medical College and Hospital, Guwahati. J Appl Pharm Sci. 2013;3(8):144-148.
21. Tadesse SA, Belay Y, Tsegaye MK. Antibiotics Utilization Pattern in Pediatric Ward: The Case from Tertiary Teaching Hospital, South West Ethiopia. Int J Curr Res Med Sci 2015;1(2): 32–41.
22. Ahmed, A., Danmusa, U. Alkali, Y. Prescription Pattern of Antibiotics in Paediatric Wards of a Tertiary Hospital in North West Nigeria: A Retrospective Study. PharmaTutor 2019; 7 (7) :1-6.
23. Mgbahurike A.A., Ojiyi I.D, Chijioke-Nwauche I. N. Antibiotic Utilization Pattern in Pediatrics Unit South – South of Nigerian Teaching Hospital. J Med Biomed App Sci 2020;8(2), 337-342.
24. Ahmed H. Effects of poverty on child health and paediatric practice in Nigeria: An overview. Ann Afr Med. 2007;6(4):142-156.
25. Kissoon N, Uyeki TM. Sepsis and the Global Burden of Disease in Children. JAMA Pediatrics. 2016;170(2):107-108.
26. Njozi M, Amuri M, Selemani M, Masanja I, Kigahe B, Khatib R, et al. Predictors of antibiotics co-prescription with antimalarials for patients presenting with fever in rural Tanzania. BMC public health. 2013;13:1097-1097.
27. Smith MJ, Gerber JS, Hersh AL. Inpatient Antimicrobial Stewardship in Pediatrics: A Systematic Review. J Pediatric Infect Dis Soc. 2015;4(4):e127-135
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