Prevalence of various inappropriate antibiotic doses among pediatric patients of in-patient, out-patient, and emergency care units in Bangladesh: a cross-sectional study (original) (raw)
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PLOS GLOBAL PUBLIC HEALTH, 2024
The heterogeneous pediatric populations, their physiological differences, along with the necessity of performing additional dose calculation, make the pediatric population more vulnerable to the incidences of inappropriate antibiotic doses. This study was conducted to examine and evaluate the appropriateness of antibiotic doses. A cross-sectional study with a quantitative approach was conducted in three hospitals located in Savar from January 06, 2021 to October 17, 2022. This study had used a convenient sampling method to collect 405 filled prescription orders from heterogeneous pediatric patients prescribed by physicians from emergency, inpatient, and outpatient care units of various clinical settings. The Harriet Lane Handbook was used as reference to investigate inappropriate doses of antibiotics. Subsequently, all analyses were conducted using the RStudio 1.3.959 software. Binary logistic regression was used to assess the risk of inappropriate antibiotic prescription in pediatrics. The overall prevalence of inappropriate antibiotic dosing in pediatrics was 335 out of 545 (61.5%). Overdosing (36.3%) and oral antibiotic prescriptions (64%) were more common than underdosing (20.4%) and parenteral antibiotics (36%). The majority (230 out of 405, 56.8%) of pediatric patients had prescriptions with inappropriate antibiotic doses, with prevalence rates of 33.8% for inpatients, 86.7% for outpatients, and 50% for emergency pediatrics. The results also indicated that pediatric patients in outdoor and emergency care units, infants, toddlers, and early childhood, those prescribed two antibiotics simultaneously, and those receiving parenteral antibiotics, were less likely to have inappropriate antibiotic dosages in their prescriptions. This study demonstrated that about one out of every two prescriptions had inappropriate antibiotic doses; in particular, prescriptions containing only oneantibiotic exhibited a substantial proportion of inappropriate antibiotic doses. Inappropriate antibiotic doses may result in therapeutic failure, patient harm, and antibiotic resistance. Good clinical pharmacy practice and careful adherence to pediatric dosing standards may minimize inappropriate antibiotic doses.
Antibiotic Use Among Children Under 5 Years of Age in a Tertiary Care Hospital, Bangladesh
SN Comprehensive Clinical Medicine, 2021
Antimicrobial resistance is common in low-middle-income countries caused by inappropriate and irrational use of antibiotics in humans and animals. Bangladesh has very limited information on antibiotic use and associated resistance. This study explored the prescribing pattern of antibiotics uses among children visiting a tertiary care hospital in Bangladesh. We conducted a cross-sectional study among 400 hospitalized children less than 5 years of age from February to April, 2019, in a tertiary hospital in Bangladesh. Among the 400 children, >50% belonged to the age group for less than 1 year and >60% were male. The average hospital stay period was 3 days (range 1–14 days). The majority of the children had a history of respiratory illnesses (32.2%) and 31% had diarrhea. Most of the children (81.7%) were prescribed one or more antibiotics. The average number of antibiotics per child was 1.17. A combined form of antibiotics was prescribed in 17.43% of children. A total of 14 diffe...
Excessive antimicrobial use leads to adverse drug effects, thus increased healthcare costs and promoting the emergence of antimicrobial resistance worldwide. The aim of the study was to evaluate the prescription pattern of antibiotics in pediatric outpatients at private hospitals in Rajshahi city of Bangladesh. WHO / INRUD prescribing indicators were used for the analysis of prescription pattern. A total of 329 pediatric prescriptions were analyzed of which 54% male and 46% female. Most of the patients (48%) belongs to the age group of 1 year-6 years. Body weight was not mentioned in 17% of prescriptions , diagnosis was confirmed only in 11% patients and also 11% of children did not take or completed immunization. Among the children born 83% were of caesarian and 17% of normal delivery. The results also indicated that 964 drugs were used by the patients with an average 2.93 per prescription. However, none of the drugs was prescribed in generic name. Interestingly, only 37.24% drugs were prescribed from the national essential drug list. Children were mainly suffering from fever and common cold 50% and pneumonia 12%. In this study, the percentage of prescriptions with antibiotics were 83% of which major classes were cephalosporin 45.27%, β-lactam antibiotics 22.97%, macrolides 18.92% and quinolones 9.46%. Analgesics 16%, vitamins 8%, drugs for acid related disorders 2% and mineral supplements 2% were also prescribed. Cost of antibiotic per prescription was 299.38 taka. This study revealed that the prescription pattern was irrational resulting from an indiscriminate use of antimicrobials irrespective to the age of patients.
Journal of Nepal Paediatric Society
Introduction: Due to complex dosage calculations, requirement and different pharmacokinetics profile of drugs in paediatric population, there is a risk of development of drug resistance due to the excessive and inappropriate use of antibiotics. The aim of this study is to determine the antibiotic prescriptions pattern and analyse the rationale use of antibiotic in paediatric patient. Methods: A prospective observational study was carried out for the period of six months. Data was obtained from the records of paediatric patients between six months to 12 years of age who visited the hospital for febrile illnesses. Appropriateness of the prescriptions was evaluated by considering various parameters like selection of antibiotics (adherence to standard treatment protocols of childhood febrile illnesses), dose, dosage form, route, frequency and duration of antibiotic administration. Quantitative data was analysed in terms of percentage and graphs. Results: One hundred and fifty prescripti...
Antibiotics are the key drugs for treatment of infections and are among the most commonly prescribed drugs in Pediatrics department. 1 Their indiscriminate use increases the risk of bacterial drug resistance and thus has prompted the need to use antibiotics judiciously in pediatric practice. 2 Studies reported that 50% to 85% of children receive antibiotics in developed and developing countries. 3 Rational antibiotic prescription is very important to avoid multiple drug resistance, treatment failure, noncompliance and increase in cost of treatment. 4 Irrational prescribing is a global problem. The rationality of prescribing pattern is of utmost importance because bad prescribing habits including misuse, overuse and underuse of medicines can lead to unsafe treatment, exacerbation of the disease, health hazards, and economic burden on the patients and wastage of resources. Examples of irrational use of medicines include: poly-pharmacy, inadequate dosage, and use of antimicrobials even for non-bacterial infections, excessive use of injections when oral forms are available and inappropriate, self-medication and noncompliance to dosing regimes. 5
Annals of Clinical Microbiology and Antimicrobials, 2014
Background: Antibiotics prescribing by physicians have gained due importance across the globe, mainly because of an increase in antibiotic usage, prevalence of infections and drug resistances. The present study is aimed to evaluate the physicians prescribing pattern of antibiotics, their usages by outpatients and disease conditions for which the antibiotics are prescribed in three cities of Bangladesh.
Global Journal of Public Health Medicine, 2020
Introduction: Antimicrobial agents are common employ in paediatric patients. Emergency department make good place for known prescribing pattern of antibiotics with frequent use for disease that interfere in treatment between private pharmacy & hospital. The irrational and overuse of antibiotic in last decades did not follow the international guidelines and infectious strategy which if not controlled or minimize will lead to higher rates of mortality in human societies. The aim was to find the magnitude of antibiotics prescribing in children internal emergency department at Basra hospital for Maternity and Children & showing relationship with misuse of it Methods: The study was performed on 560 paediatrics patients aged (1 month-13 years) that seen in the (Basra Hospital for Maternity and Children) emergency department during 4 months from December 2017 to March 2018. These cases were dividing according to containment antibiotic and several parameters such as patient diagnosis and number of antibiotics prescribed. Results: A total of 61% (n=342) patients were males. The average number of antibiotics per patient was 1.45 Prescription did not contain antibiotics 28.57% (n=160) Prescription contain antibiotics 71.42% (n =400) of all patient from total prescribed. Most cases diagnosis for prescribing antibiotics are (24%) Gastroenteritis (16.25%) bronchiolitis and (11.75%) pneumonia. Conclusion: The dispensing of antibiotics is not following constant or international guidelines which will cause problems like resistance and economic side also. Nearly almost the admitted patients received antibiotics regardless the culture results.
PLOS ONE, 2015
Introduction Infectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India. Methods Data from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008-2011) using a customized form. Data from inpatients aged 0-18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant. Results Oftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95%confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral-and enteric fever were frequently prescribed PLOS ONE |
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.