A Prospective Study on Cephalosporin Utilization by Pattern in Pediatric Patients

Abstract

Pediatric is the medicine specialization concerned with the health of infants, children, and adolescents. Worldwide, many infectious diseases were controlled in the 20th century by improving living standards, public health, and various antimicrobial agents. Antibiotics, in particular, cephalosporin, are amongst the most widely dispensed medications in Pediatric departments worldwide, especially in countries where there are no strict guidelines to regulate their use. A prospective cross-sectional study was conducted at 150 Bedded Pediatric ward of Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Shaheed Benazirabad to assess the utilization pattern of cephalosporin among all admitted in-patients. Patients' demographic details were recorded from the Patient's Bedside File (PBF). Data were analyzed by using Microsoft Excel and Microsoft SPSS 20. Among all admitted patients, 1285 patients met the inclusion criteria, and their PBF were evaluated for cephalosporin. A total of 2863 antibiotics were prescribed among 1932 patients. The most commonly prescribed class of antibiotics among the study population was Cephalosporin 1971 (68.83%), followed by Cefotaxime (20.39%). 76.20% of pediatric patients were prescribed antibiotics through the parenteral route and 23.8% through the oral route. The most common diagnosis was Pneumonia (23.4%), diarrhea (11.6%), and Bronchitis (11.2%), following other indications. Antibiotics were being prescribed without national antibiotic guidelines or institutionally approved protocols, which are currently unavailable. The study findings shall help the hospital administration and government design and implement official policies to promote rational utilization of antibiotics.

Cephalosporins in pediatrics: Navigating antimicrobial resistance impact and adverse effects – A comprehensive review

“…31 As many infectious diseases become resistant to antimicrobials, it is a serious cause for concern that antimicrobial resistance might become a significant issue and cause future problems for the child or patient. 13 Antibiotic off-label usage, in which many antibiotic prescriptions are written for the same patient, is the main source of concern. The majority of off-label medicines these days are written for neonates.…”

“…12 More than 50% of in-patient pediatrics were on antibiotics, especially on third- generation antibiotics without diagnosis or provisional diagnosis. 13 Cephalosporins are more prioritized than Penicillins and cephalosporins were proven more beneficial in bacteriology because of their low toxicity and high safety effect. 13,14 Another reason for the Cephalosporin priority over penicillin is the increased report of allergic reactions with penicillin, as some patients are hypersensitive to penicillin.…”

“…13 Cephalosporins are more prioritized than Penicillins and cephalosporins were proven more beneficial in bacteriology because of their low toxicity and high safety effect. 13,14 Another reason for the Cephalosporin priority over penicillin is the increased report of allergic reactions with penicillin, as some patients are hypersensitive to penicillin. 13 In that the number of prescriptions for third generation cephalosporins increased from 2010 to 2014 most remarkably; simultaneously there was a marked decrease in the use of first and second-generation cephalosporins in pediatric patients.…”

“…13,14 Another reason for the Cephalosporin priority over penicillin is the increased report of allergic reactions with penicillin, as some patients are hypersensitive to penicillin. 13 In that the number of prescriptions for third generation cephalosporins increased from 2010 to 2014 most remarkably; simultaneously there was a marked decrease in the use of first and second-generation cephalosporins in pediatric patients. The third generation cephalosporins are active against both gram-negative and positive bacteria but more active against gram-negative bacteria and useful for the organisms which are resistant to the first and second-generation cephalosporins.…”

“…15 Non-constrained usage of third-generation cephalosporins may enhance Escherichia coli and Klebsiella pneumonia resistance. 13 In the pediatric population with the risk factor of rapid decline in enteral nutrition, long-term hunger, and weight loss, the use of third-generation cephalosporin might produce adverse effects such as pseudolithiasis and reversible cholelithiasis. Pseudolithiasis and reversible cholelithiasis are conditions that develop after the complex formation between ceftriaxone with calcium which gets precipitated in the gallbladder, resulting in abnormalities in the gallbladder on ultrasonography.…”