Rationality of Antibiotic Usage in Pediatrics in Bengkulu, Indonesia: Gyssens? Criteria and Type of Therapy Analysis

Abstract

Infectious diseases are one of the biggest health problems not only in Indonesia, but also in the whole world. Prescribing antibiotics in Indonesia are quite high and increased the incidence of resistance. This study is aimed to evaluate the rationality of antibiotic use in children at the hospital qualitatively. This research is descriptive analysis of retrospective antibiotic prescribing data in children use a Gyssens' criteria and types of antibiotic therapy. Incidence of infection in children under 12 y of age amounted to 93.2%. The analysis results by using the Gyssens' criteria are obtained category O (rational use) of 32%, V (no indication) of 27.4%, inappropriate dose (IIA) of 0.6%, inappropriate interval (IIB) of 1.7%, duration too short (IIIA) of 2.9%, duration too long (IIIB) of 11.4%, alternative more effective (IVA) of 17.7%, alternative less toxic (IVB) of 2.9%, alternative less cost (IVC) of 2.9% and alternative narrower spectrum (IVD) of 0.6%. The results showed that the grouping of most types of therapy was antimicrobial drugs empiric therapy in 47.4% cases followed successively by antimicrobial drugs unknown therapy 32.6%, antimicrobial drugs documented therapy amounted to 12%, antimicrobial drugs extended empiric therapy amounted to 6.9% and antimicrobial drugs prophylaxis therapy amounted to 1.1%. The use of antibiotics in paediatric patients at the hospital in Bengkulu, Indonesia substantially has been inappropriate based on qualitative analysis. Key words: Antibiotics, paediatric, Gyssens' criteriaInfectious diseases in Indonesia are still among the top ten most prevalent diseases. Most infections, especially in children under 5 y old (toddlers) are acute respiratory tract infections amounted to 18% [1] . The prevalence of respiratory infections and pneumonia are highest in the age group 1-4 years in the population of Indonesia. An antibiotic prescribing in Indonesia is quite high, which might contribute to increase in the incidence of resistance. The impact of antibiotic resistance is increasing the morbidity, mortality and health care costs. In the last decade, many microorganisms showed an increase in the incidence of resistance to standard therapy. It is an estimated worldwide phenomenon caused by misuse and overuse of antibiotics.A study in two major cities in Indonesia (Semarang and Surabaya) found 76% of prescribing antibiotics were intended for groups of paediatric patients. Another report from the city of Denpasar, Indonesia showed that antibiotic prescriptions for children was at a high level of 265 prescriptions (90.4%) out of a total of 293 [2] . In the United States, each year a large number of antibiotic prescriptions are for children and out of those in 50% of the cases, prescribing an antibiotic was not indicated [3] . In Canada, 74% of preschool children were prescribed antibiotics for the treatment of respiratory infections and 85% of these cases got a prescription for an antibiotic, when not needed [4] . Most at risk were young children, teenagers, and those with medical ...

The Rationality of Antibiotics Therapy Toward Children With Typhoid Fever at M.M. Dunda Hospital

“…This study showed that the increase of children age of the incidence of typhoid fever was reduced. This was in line with previous research findings that the rate of infection in children decreased on age [7].…”

“…The results obtained in the study were high category which compared with previous studies obtaining the results that the use of antibiotics for Bengkulu hospital 0.6% belonging to not exactly dose [7].…”

“…A total of 47 prescriptions (52%) fall into category 0, i.e., the rational use of antibiotics in which antibiotics are given a clear indication relating to the patient's needs (assessed for efficacy, safety, suitability and cost), dose, appropriate intervals and delivery routes and time. Meanwhile, the previous studies showed 32% of children with typhoid receiving rational antibiotic therapy [7].…”

“…Whereas, according to the WHO, it is stated that the use of ceftriaxone to achieve optimal therapy was 10-14 days [8], for example, for giving too short of administration of antibiotics ceftriaxone 2 times a day with a dose of 225 mg in patients having body weight 9 kg and given only for 2 days. In Indonesia, the use of antibiotics is in the range of 3-7 days to kill disease-causing microbes [7,21]. If the treatment was done too short, the therapy will not be optimal and in the long run which will cause the resistance of antibiotics.…”

“…In the past decade, many microorganisms have been resistant to antibiotics that exist in some therapeutic standards. This is a phenomenon occurring almost all over the world caused by excessive abuse and antibiotics use [7]. Based on the above description, the researcher felt that it was necessary to evaluate the rationality of antibiotic therapy in child fever at M.M Dunda to support the success of typhoid therapy and reduce the appearance of resistant microorganisms against antibiotics.…”