Appropriateness and Pattern of Antibiotic Prescription in Pediatric Patients at Adigart General Hospital, Tigray, Ethiopia

Abstract

Background. Inappropriate and unnecessary use of antibiotics can increase morbidity, mortality, medical expenses or patient cost, and microbial antibiotic resistance. However, in developing countries like Ethiopia, information regarding appropriateness of antibiotic prescribing pattern to guide improvement strategies is scant. Objective. The aim of this study was to assess appropriateness and pattern of antibiotic prescription in pediatric patients at pediatric ward of Adigrat General Hospital. Methods. Hospital-based retrospective cross-sectional study was conducted to assess the antibiotic prescribing pattern in pediatric inpatient and outpatient ward of Adigrat General Hospital from December 1, 2018 to April 30, 2019. Data was collected by using structured data collection checklist, and the systematic random sampling technique was employed to enroll the required sample size during the study period. Appropriateness of drug use in pediatrics was evaluated using Ethiopian Standard Treatment guideline and WHO pediatric guideline. Result. A total of 692 pediatric patients’ medical charts were reviewed. The median age of patients on antibiotics was 3.26 years (IQR: 2-4). Majority (49.13%) of the patients were hospitalized for 5-9 days. SCAP (195), tonsillitis (114), and cellulitis (99) were most frequently encountered pediatric diseases. Penicillins (37.86%) followed by cephalosporins (31.79%) antibiotics were the most prescribed antibiotics in pediatric wards. This study also showed that ceftriaxone and ceftriaxone+amoxicillin were the most frequently used single and combination antibiotics, respectively. The prescribing practices were not stick to WHO core indicators and standards. Inappropriate prescription of antibiotics was observed in 28.3% of patients. Advanced age of children, children aged between 6 to 10 years ( AOR = 3.225 ; CI = 1.080 − 9.630 ; P = .036 ) and 11-18 years ( AOR = 18.691 ; CI = 5.156 − 67.756 ; P = .000 ), was the independent determinant of inappropriate drug use. Conclusion. Inappropriate antibiotic prescribing was encountered in 28.3% of children. The rate of generic prescription was not in line with WHO recommendation. Advanced age of children was the independent factor for inappropriate use of antibiotics.

Evaluation of Antibiotic Prescribing Pattern and Appropriateness among Hospitalized Pediatric Patients: Findings from a Malaysian Teaching Hospital

“…Inappropriate antibiotic prescribing was found in 57% of the patients. This incidence rate of IAP is higher than what was found in Turkey (47%) [ 11 ], Pakistan (41%) [ 12 ] and Ethiopia (28%) [ 29 ]. This could be attributed to the lack of established hospital antibiotic guidelines in our teaching hospital and the difference in the types of infections encountered.…”

“…However, both conditions are believed to be viral infections that do not need empirical antibiotic use [ 20 , 30 ]. The use of antibiotics for viral infections and AGE was also reported as a common IAP in other countries [ 9 , 29 ]. It is important to note here that no laboratory confirmatory test for diagnosis was reported in the patients’ electronic charts.…”

Antibiotic Prescription Pattern, Appropriateness, and Associated Factors in Patients Admitted to Pediatric Wards of Tibebe Ghion Specialized Hospital, Bahir Dar, North West Ethiopia

“…This disparity could be due to differences in prescribers’ attention in considering differences in dosing of school-age, adolescent, and adult patients. 20 In another study, conducted in Vietnam, comorbidities and duration of antibiotic treatment were significantly associated with inappropriate antibiotic usage. 14 …”

“…This result is in line with a study conducted in India, where the majority of patients (44%) were exposed to the wrong antibiotic indication, 3 but it is not concordance with a study conducted in Adigrat General Hospital, where the majority of patients encountered inappropriate use of antibiotics due to high or low doses and the overall level of inappropriateness of antibiotic use was slightly lower (28.3%) than in our study. 20 Ceftriaxone has been prescribed to pediatric patients below 2 months of age even though the drug is contraindicated owing to its kernicterus adverse effect, and azithromycin has been prescribed to pediatric patients below 6 weeks of age even though it is contraindicated owing to its infantile hypertrophic pyloric stenosis (IHPS) adverse effects. However, these drugs may have been used because of the unavailability of safer alternative agents.…”

Antibiotic prescribing patterns at children’s outpatient departments of primary care institutions in Southwest China

“…In addition, we used a very strict definition of drug combinations: more than one systemic antibiotic by injection or oral administration at a time by an outpatient physician without any indication. Previous studies [44][45][46] have raised the issue of antibiotic combinations. Therefore, even if the numbers are low, "Incorrect spectrum of antibiotics" and "Combined use of antibiotics" are still a non-negligible problem in antibiotic prescription overuse.…”