To determine the proportion of children receiving antibiotics for common illnesses and to understand the antibiotic prescription ptern and factors influencing it, a cross sectional study was done among the private practitioners in Chennai, India 403 prescriptions by 40 physicians from selected health facilities were analyzed 79.9% of children with ARI (Acute respiratory infection) and ADD (Acute watery diarrhea) were prescribed antibiotics. Penicillins (43.9%) were the commonest antibiotic prescribed. Factors like postgraduate qualification, experience of physician, source and method of updating knowledge, inpatient practice setting and presence of fever influenced the antibiotic prescription.
BackgroundPneumonia is the leading cause of child mortality under five years of age worldwide. For pneumonia with chest indrawing in children aged 3–59 months, injectable penicillin and hospitalization was the recommended treatment. This increased the health care cost and exposure to nosocomial infections. We compared the clinical and cost outcomes of a seven day treatment with oral amoxicillin with the first 48 h of treatment given in the hospital (hospital group) or at home (home group).MethodsWe conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India. Children aged 3 to 59 months with chest indrawing pneumonia were randomized to home or hospital group. Clinical outcomes, treatment adherence, and patient safety were monitored through home visits on day 3, 5, 8, and 14 with an additional visit for the home group at 24 h. Clinical outcomes included treatment failure rates up to 7 days (primary outcome) and between 8–14 days (secondary outcome) using the intention to treat and per protocol analyses. Cost outcomes included direct medical, direct non-medical and indirect costs for a random 17 % subsample using the micro-costing technique.Results1118 children were enrolled and randomized to home (n = 554) or hospital group (n = 564). Both groups had similar baseline characteristics. Overall treatment failure rate was 11.5 % (per protocol analysis). The hospital group was significantly more likely to fail treatment than the home group in the intention to treat analysis. Predictors with increased risk of treatment failure at any time were age 3–11 months, receiving antibiotics within 48 h prior to enrolment and use of high polluting fuel. Death rates at 7 or 14 days did not differ significantly. (Difference −0.0 %; 95 % CI −0.5 to 0.5). The median total treatment cost was Rs. 399 for the home group versus Rs. 602 for the hospital group (p < 0.001), for the same effect of 5 % failure rate at the end of 7 days of treatment in the random subsample.ConclusionsHome based oral amoxicillin treatment was equivalent to hospital treatment for first 48 h in selected children of chest indrawing pneumonia and was cheaper. Consistent with the recent WHO simplified guidelines, management with home based oral amoxicillin for select children with only fast breathing and chest-indrawing can be a cost effective intervention.Trial RegistrationClinicalTrials.gov NCT01386840, registered 25th June 2011 and the Indian Council of Medical Research REFCTRI/2010/000629.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0510-9) contains supplementary material, which is available to authorized users.
Background and aims: Injectable penicillin and hospitalization is the recommended treatment for WHOdefined severe pneumonia in children aged 3-59 months. We determined if treatment with oral amoxicillin when administered for first 48 hours in the hospital followed by 5 days at home (hospital group) was equivalent to a 7 day ambulatory treatment (home group).
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