Appropriateness of Antibiotic use for the Management of Acute Diarrhea Among Under-Five Children Treated at Primary Care Centers in Northwest Ethiopia: A Cross-Sectional Study

Abstract

Background Acute diarrhea management is solely aimed at fluid replacement and nutritional support while antibiotics have a very limited role. Antibiotic treatment is recommended only for bloody diarrhea (dysentery), cholera and invasive bacterial diarrhea. This study is launched to assess the appropriateness of antibiotic use for the management of acute diarrhea among under-five children in Gondar town primary care centers.Methods Institutional based cross-sectional study was conducted in three primary care centers located in Gondar town, Northwest Ethiopia. Children aged from 2–59 months who visited the three primary care centers from September 12, 2015 to September 10, 2016 and received treatment for acute diarrhea were included in the study. We selected 176 cases from Azezo Health Center, 166 from Poly Health Center and 80 from Woleka Health Center. Cases were drawn using systematic random sampling technique. The findings of the study were summarized using tables and figures; binary logistic analysis was used to identify association between the independent and outcome variables at 95% confidence level where p < 0.05 was considered as statistically significant.Results The mean age of the study participants was 19.1 ± 12.8 months. The majority (60.8%) were males. Appropriate antibiotic use was recorded in less than half (47.2%) of the study subjects. Almost all (98.1%) of children subjected to inappropriate antibiotic use were those with watery diarrhea treated with antibiotics. Out of 253 children who received antidiarrheal antibiotics 202 (79.8%) had acute watery diarrhea which should not be treated with antibiotics. Children diagnosed with acute watery diarrhea were less likely to receive treatment qualified as appropriate antibiotic use [AOR: 0.003 (0.001,0.017)]. Conversely, receiving no antibiotic [AOR: 391.00 (92.46, 1653.37)] and prescriber’s profession of Clinical Nurse [AOR: 3.57 (1.02, 12.51)] were positive predictors for appropriate antibiotic use.Conclusion The findings of the study confirm the prevalence of widespread inappropriate antibiotic use on under-five children presenting with acute diarrhea. The findings can be used by stakeholders as input for promoting appropriate antibiotic use in the healthcare system as well as to deter antimicrobial resistance.

Prevalence of co-trimoxazole resistance against bacterial isolates from children with diarrhea in Ethiopia: Systematic review and Meta-analysis

“…Management of acute diarrhea focuses on uid replacement and nutritional support. According to the WHO guidelines, oral rehydration solution (ORS) with zinc is the rst-line treatment for acute diarrhea whereas antimicrobials are reserved for bloody diarrhea, cholera, and invasive bacterial diarrhea in children [7,9] . Most of the time, acute diarrheal disease is selflimiting and of viral origin, thus the use of antimicrobials is not recommended for mild or moderate and watery diarrhea.…”

“…In Ethiopia, diarrhea in children commonly gets treated empirically without identifying the real causative agent. Moreover, the cheap and wide availability of co-trimoxazole is enabling the irrational use of this medicine [9,15] . Co-trimoxazole resistance to the common bacterial enteropathogens of diarrhea has been reported with varying percentage prevalence.…”

“…The incidence of enteric bacterial resistance to commonly prescribed antimicrobials has remarkably increased [12] . Among the inappropriately prescribed (66.2%) antimicrobials for acute diarrhea in Ethiopian children, cotrimoxazole was the most inappropriately-prescribed medicine accounting for 63.6% followed by amoxicillin (2.6%) [9] . Co-trimoxazole was prescribed for the majority of the children (70.7%) who presented with diarrhea, whereas metronidazole (7%) and amoxicillin (4.6%) were less commonly prescribed drugs [15] .…”