Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India (original) (raw)
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ANTIBIOTIC USE IN PEDIATRIC INFECTIONS; A STUDY IN TERTIARY CARE HOSPITAL
Objectives: Antibiotics are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in south India, to make a profile of antibiotics use and suspected adverse drug reactions (ADRs) owing to them. Methods: Hospitalized children of either sex, aged between 1 month and 12 years, were inspected. Baseline demographic and clinical features, duration of hospital stay, antibiotics received in hospital along with dosing and indications and interest of suspected ADRs attributable to their use were recorded. Every patient was followed up till discharge, admission to the Pediatric Intensive Care Unit, or passing. Results: Over the year and a half report period 364 confirmations were screened. The prevalence of Antibiotics use was 80.22%. The majority of the 292 children who received Antibiotics were males (63.35%). Median age was 35 months, five children died. In most instances, either two (41%) or a single antibiotic (37.32%) was used. Ceftriaxone, co-amoxiclav, amikacin, vancomycin, and ampicillin were predominantly used. Antimalarials, antivirals and antiprotozoals were used occasionally. Average number of Antibiotics per patient was 2.2± 1.1 the majority (81.15%) were by parenteral route and initial choice was usually empirical. Prescriptions were usually in generic name. The antibiotic treatment went somewhere in the range of 1 and 32days, with a middle of 8 days. Five ADRs were noted of which half were skin rash and the rest loose stools. Conclusions: The profile of Antibiotic utilize is comprehensively like prior Indian investigations. Apparent overuse of multiple Antibiotics per prescription and the parenteral route requires exploration. Antibiotics are being used empirically in the absence of policy. ADRs to Antibiotics are occasional and usually mild. The benchmark information can serve in situation analysis for antibiotic prescribing guidelines.
Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases
Archives of Pediatric Infectious Diseases, 2017
Background: Antibiotic misuse is a major cause of antimicrobial resistance. Objectives: The present study aimed at determining the pattern of antibiotic usage in previously healthy children hospitalized for common infectious diseases in a tertiary care children's hospital. Methods: This study was the second part of a previous study in which inpatient charts of children hospitalized from October 2013 to September 2014 were reviewed to determine the rationality of drug use. Data from the first study were analyzed to define the antibiotic usage pattern in urinary tract infection, acute meningitis, community acquired pneumonia, fever without a localized source and acute gastro-enteritis. The data were checked independently by two pediatric infectious disease specialists to assess the appropriateness of prescribed antibiotics and in case of disagreement, rechecked by a third member. Results: Hospital charts of 140 children were reviewed; 47 had been treated for urinary tract infection, 31 for pneumonia, 25 for acute meningitis, 24 for acute gastroenteritis and 13 for fever without a localized source. One-hundred and fourteen children (81.42%) received 208 prescriptions for antibiotics (1.82 antibiotics/patient). Nineteen different antibacterial drugs and 2 antivirals (acyclovir and oseltamivir) were prescribed. Most frequently prescribed antibiotic was ceftriaxone. More than 25% of prescriptions for antibiotics were needless. In 91.6% of the prescriptions the medications had been prescribed by generic names. Dosing errors were observed in less than 7% and patients received the medication for prolonged duration, 25.6% of times. Conclusions: Nonuniformity of antibiotic usage, a high rate of needless antibiotic prescriptions, and prolonged administration found in this study call for stringent antibiotic stewardship.
Journal of Nepal Paediatric Society, 2018
Introduction: Infectious diseases are one of the most frequent reasons for hospital admission for children and antimicrobials are commonly used to treat them. There is higher prevalence of irrational prescriptions of antimicrobials in such population. This study was conducted to survey the pattern of antimicrobial prescription in Paediatric inpatient. Material and Methods: This was retrospective, descriptive, observational study. The data was collected from prescription records. The paediatric population included in the study was categorised into three age groups. A total of 87 prescriptions were studied and the information was recorded in performa. Data were recorded in MS Excel and Graph Pad Prism version 6 was used for analysis. Results: The number of male child was outnumbered by female child. The average age of the patient on antimicrobial prescription was 5.34 ± 2.18 years. The mean duration of hospital stay was 6.17 ± 2.01 days. The common indications for antimicrobial prescriptions were upper respiratory tract infections, diarrhoeal illness, urinary tract infections, enteric fever, etc. The antimicrobials prescription rate was 1.33. Oral route was found to be commonly used than parenteral route. The generic prescription rate was 33.6%. The most common drug prescribed was ceftriaxone followed by amoxicillin + clavulanic acid, ciprofloxacin, metronidazole and amikacin. The 62.5% of antimicrobials were prescribed from National Essential List of Medicines. Conclusion: This study highlights the prescription pattern of antimicrobial agents in hospitalised Paediatric population in a tertiary care hospital.
International Journal of Research in Medical Sciences, 2015
Background: The inevitable consequence of the widespread use of antimicrobial agents has been the emergence of antibiotic resistant pathogens. The rising incidence of bacterial resistance to common antibiotics, particularly, multidrug resistant pneumococci, has prompted the need to use antibiotics judiciously in paediatric practice. The present study thus attempted to understand the antibiotic usage pattern among inpatients in a paediatric ward of a tertiary care hospital. Methods: A cross-sectional study was carried out for three months among the inpatients in the Department of Pediatrics in a tertiary care teaching hospital, Kolkata. The data regarding patient's demographics and antibiotic use was collected daily in a pre-structured proforma. A descriptive statistical analysis of the data was performed. Results: A total of 124 patients were screened of which males and females represented 58.06% and 41.94% of the cases respectively with age group of 2-14 years presenting in majority. Among various causes of hospitalization, prevalence of respiratory disorders were maximum (25.81%), followed by hematological disorders (25%). Among various categories of prescribed drugs, antibiotics were found to be maximum (39.25%). Beta-lactum antibiotics were prescribed in majority (64.41%) with 56.91% being of cephalosporin group. The preferred route of administration was found to be parenteral (64%). 61.29 % cases were ordered laboratory investigations prior to the antimicrobial therapy initiation. About 63.16% of the total samples for culture & sensitivity tested were reported positive. 39.58% of these positive cases showed resistance to empirical antibiotic therapy on lab reports. Conclusions: The study enables to obtain information on the antibiotic usage pattern in the pediatric population, focusing on prevalence of antibiotic misuse in our setup and suggesting strategies of its minimization.
International Journal of Basic & Clinical Pharmacology, 2014
Background: The pediatric population comprises of 20-25% of the total world population, and numerous acute and chronic diseases can effect this sub population. Antibiotics are among the most frequently prescribed classes of medications for children. Methods: The study is prospective interventional study carried out in the pediatric outpatient of the MIMS for a period of 3 months (September-November 2013+1 month for analysis). Results: Most (84%) children were given single antimicrobial agent and 16% were given more than one antimicrobial or fixed dose combination of the antimicrobial agent. Amoxicillin (48%), erythromycin (20%) and cefixime (16%) were found to be the most frequently used antibiotics. Conclusions: The high percentage of prescriptions involving antimicrobials observed in MIMS requires rational use of antimicrobials and judicious prescribing. It should be followed by the appropriate use of the selected medicine from the NLEM with frequent update of information. The implementation of antibiotic policy and treatment guidelines with periodic assessment of the clinical pharmacologist in the study area is very important in order to monitor the clinical use of these medications.
Outpatient prescribing and antibiotic use for children in a tertiary hospital
Sahel Medical Journal, 2020
Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2-year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20(IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic-containing prescriptions had one antibiotic prescribed while β-lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing.
Evaluation of antibiotic prescribing pattern in pediatrics in a tertiary care hospital
Avicenna Journal of Medicine, 2021
Background: The irrational use of antibiotics is a global issue and it can lead to morbidity, mortality, and increased health care costs. Hence, proper use of antibiotics is imperative and should be included in the pharmaceutical care plan. Objective: The objective of this study was to evaluate the prescribing pattern of antibiotics for children using WHO core prescribing indicators. Materials and Methods: A prospective, observational study was carried for 6 months in the pediatric department at a tertiary care hospital, Pune. The WHO prescribing indicators were used to evaluate the prescriptions, and the ideal WHO range was considered as a determining factor for rational prescription. Results: A total of 302 patients were included in the study, with a mean patient age of 4.92 ± 4 years. The average number of drugs per encounter was 6.12 (WHO standard is less than 2). The percentage of antibiotics prescribed was 26.3% with an average of 1.63 antibiotics per prescription. Of the 493 ...
Antibiotic Utilization in Pediatric In-Patients at a Tertiary Care Unit
The Professional Medical Journal, 2019
Objectives: Antibiotics are key drugs which are used for the treatment of infectious disease and are among the drug that are most frequently prescribe in pediatric patients. This study was designed to assess antibiotics utilization patterns in pediatric ward of a tertiary care teaching unit, Peshawar. Study Design: A retrospective cross sectional study. Setting: Pediatric ward by evaluating antibiotics utilization patterns in pediatric ward of a tertiary care teaching unite, Peshawar. Period: January, 2017 up to March, 2017. Method: Results: There were 219 patients included in the study. In this study, the major medical conditions for which antibiotics were prescribed include pneumonia (23.28%). The most commonly used antibiotics were ceftriaxone, 46.21%, while the most commonly prescribed multiple antibiotics were ceftriaxone plus ampicillin (21.9%) followed by Ceftriaxone & Metronidazole. The average number of antibiotics per prescription was 1.75. At least 114 (52%) patients were...
Journal of Hospital Administration, 2018
Background: The burden of infectious diseases among Nigerian children is high. These children are often prescribed antibiotics during periods of hospitalisation. Unfortunately antibiotic resistance (ABR) threatens the availability and efficacy of antibiotics for use by vulnerable children and the future generations. Monitoring prescribing trends in our hospital as a means of identifying targets for improving prescribing is inevitable. Objective: The aim of the study was to evaluate antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a Paediatric hospital in Nigeria. Methods: A retrospective survey was carried out using case notes of previously hospitalised patients admitted between January and June 2016. Data from 150 case notes of patients admitted for suspected bacterial infections were collected using a predesigned data collection form. Patients' demographics, infection type, details of prescribed antibiotics, length of hospital stay and microbiological assessments were noted. Data were analysed using statistical package for social sciences (SPSS) version 22. Frequencies and percentages were calculated for categorical variables. Means and standard deviations were calculated for continuous (numerical) variables. Correlation was also employed in the analysis. Results: Of the 150 patients, 53.3% were males and 86% were children under 5 years of age. The mean duration of hospital stay was 7.59 (± 5.4) days. The most common infections were respiratory tract infection (32%) and sepsis (31.3%). The most common empirically prescribed antibiotics at the onset of admission were Gentamicin and a fixed dose combination of Ampicillin/Cloxacillin which were prescribed for 64.7% and 52.7% of the patients respectively. Cultures were ordered for only 7 (4.7%) of patients at the onset of hospitalisation. All antibiotics administered on admission were parenteral formulations and only 4% of the patients had their antibiotic switched to oral route on or before the third day of patients' admission. Another 71.3% were converted to oral formulations on the day of discharge from the hospital. A total of 87.3% were discharged on antibiotics and the most commonly prescribed antibiotic at discharge was Cefixime (37.2% of antibiotics prescribed as take home medication). Conclusions: Antibiotics were started empirically in all cases and cultures were ordered for few patients at the start of antibiotic therapy. Cultures should be more frequently ordered in the hospital to guide antibiotic prescribing for patients admitted for suspected bacterial infections. In addition, timely intravenous (IV) to oral (PO) antibiotic switch should be practised whenever appropriate. Educating physicians on the benefits of early switch from IV to PO formulations when appropriate is also recommended. Initiatives such as the "Antibiotic Time out" or Start Smart-then Focus approach will be appropriate in the hospital. Introduction of an empiric antibiotic policy in the hospital is highly recommended.