Antibiotic prescribing practice in the management of cough or diarrhea among children attending hospitals in Addis Ababa: a cross-sectional study

Abstract

BackgroundIrrational use of antibiotics is a global problem. Failure to follow clinical guidelines is one of the main reasons for irrational use of antibiotics. Cough and/or diarrhea are the main childhood illnesses in Ethiopia, and health care providers are expected to follow the national guideline while managing these illnesses. This study tried to assess the extent of adherence to the guideline while managing cases of childhood diarrhea and/or cough.MethodsThe study was conducted in 23 hospitals in Addis Ababa. Data were collected prospectively from April to June 2016 using a structured questionnaire. A total of 1,073 children aged 2–59 months who visited the hospitals for cough or diarrhea during the study period were included in the study. Equal number of cases were allocated to each hospital and consecutive cases were included in the study until the calculated sample size was attained for each hospital. Data collectors approached cases after they were seen by the health care provider. SPSS version 20 was used to analyze the data.ResultOf the total number of cases, an antibiotic was prescribed for 794 (74.0%) of the children. Cotrimoxazol 209 (26.3%), amoxicillin 185 (23.3%), and cephalosporines 174 (21.9%) were the three most commonly prescribed antibiotics. Six hundred eighty-eight (86.6%) of the prescriptions were determined to be inappropriate. Of the inappropriate prescriptions, 631 (91.7%) were for prescribing antibiotics when not necessary and 57 (8.3%) were for prescribing the wrong spectrum of antibiotics. Using multivariate analysis, a child not having diarrhea was independently associated with appropriate antibiotic prescription (adjusted odds ratio =0.261, 95% confidence interval: 0.095–0.714). The prescriber being qualified as a pediatrician was an independent predictor of inappropriate antibiotic prescription (adjusted odds ratio =9.967, 95% confidence interval: 4.221–23.532).ConclusionThe magnitude of inappropriate antibiotic prescription while managing cough and/or diarrhea in our setting was high. It needs urgent action to prevent emergence of antibiotic-resistant microorganisms.

The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—A systematic review

“…In comparison, respondents from a study in developed countries showed lesser confidence in planning the duration of antibiotic treatment, or selection of more than one antibiotic for a combination therapy, than choosing the right antibiotic . An overly high confidence in the use of antibiotics without adequate knowledge on local antibiotic resistance patterns, especially when coupled with difficulty in choosing the correct antibiotic, could be one reason for the high rates of inappropriate antibiotic prescribing in developing countries, as shown by a recent study in Ethiopia, where most of the prescribed antibiotics were not in accordance with national guidelines and most of these inappropriate prescriptions were not required …”

“…32 An overly high confidence in the use of antibiotics without adequate knowledge on local antibiotic resistance patterns, especially when coupled with difficulty in choosing the correct antibiotic, could be one reason for the high rates of inappropriate antibiotic prescribing in developing countries, as shown by a recent study in Ethiopia, where most of the prescribed antibiotics were not in accordance with national guidelines and most of these inappropriate prescriptions were not required. 39 TA B L E 2 Commonly used guide when prescribing antibiotics The reported variation in what the respondents use to guide their antibiotic prescribing and the recommendations highlighted to improve antibiotic prescribing could probably be explained by the differences in the available services in the different settings, or problems with their acceptability, local guidelines versus international guidelines for example. 15,17 Thus, the use of local guidelines or advice from experts such as pharmacists may not be available in all settings which could have therefore led to their more limited report by the studies.…”

Antibiotic prescription patterns for treating dental infections in children among general and pediatric dentists in teaching institutions of Karachi, Pakistan

“…Although infectious diseases are more common in developing countries, such as Pakistan, due to poor hygienic condition of hospitals, the surgeons usually overprescribe broad spectrum antibiotics which may add to the burden of AMR [40]. A study done in Ethiopia where national antibiotic prescription guidelines were mostly not followed showed that lack of the knowledge of local resistance patterns is probably the reason for injudicious antibiotic prescription pattern seen in the developing world, [41].…”

Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals

“…Typical features of prescribing in LMICs include high volumes of antibiotic prescribing [16], although these higher levels can be partially linked to greater burden of infectious diseases [17]. Prescribing in LMICs has also been characterized by high empirical use of broad-spectrum antibiotics [8,18,19], non-availability of and/or poor compliance with treatment guidelines [20] and limited use of diagnostic tests [21].…”