Objectives. (1) To determine the indications, frequency, and types of antibiotics used in hospitalized paediatric patients at tertiary care hospital and (2) to evaluate whether the prescribed antibiotics were based on the isolation of organism and their sensitivity. Study Design. Descriptive observational hospital based study. Results. A total of 131 patients were included over 6 months of study period, in whom antibiotics were prescribed at the time of admission. The majority were between 1 and 5 years of age. M？:？F ratio was 1？:？1. Fever was the commonest symptom (in 84% of cases) followed by gastroenteritis. Blood culture was done in 114 cases (87%) and was positive only in 10 (8.8%). The commonest organism isolated from blood was Salmonella Typhi. Ceftriaxone was found to be the most frequently prescribed antibiotic as an empirical therapy. 102 (77.86%) patients received Ceftriaxone, followed by ampicillin. The antibiotics were probably used on the basis of clinical condition rather than the result of blood culture, as yield of blood culture was quite low. Conclusion. Our study showed an unjustified use of antibiotics regardless of the admission and discharge diagnosis in acute febrile illnesses. Further on, inappropriate practice of using Ceftriaxone was noted in LRTI and pneumonia. Efforts are needed to educate physicians about the rational use of antibiotics. 1. Introduction Antimicrobial agents are among the most frequently prescribed drugs. Inappropriate use of these agents is associated with allergic reactions, toxicity, super infection, and more importantly development of antimicrobial resistance [1]. The excessive and inappropriate use of antibiotics adds an unnecessary economic burden to health care system and coincides with increase in drug resistant organisms [2]. It has been observed in many studies that patients with drug resistant organisms require longer hospitalization and had increased risk of mortality [2]. Rational drug therapy is defined as the use of drugs only when there is specific need. Once the need has been established, then a proper drug has to be selected on the basis of efficacy, safety, cost, effectiveness, availability, acceptability, and dosage form [3]. On the other hand, inappropriate or irrational use of drugs is described by James Trostle as “consumption of drugs in a way that reduces or negates their efficacy or in a situation where they are unlikely to have desired effect” [3]. A study conducted at Karachi showed improper use of antibiotics in acute watery diarrhea in 39% of cases [4, 5]. Various studies have
References
[1]
S. E. Cosgrove and Y. Carmeli, “The impact of antimicrobial resistance on health and economic outcomes,” Clinical Infectious Diseases, vol. 36, no. 11, pp. 1433–1437, 2003.
[2]
T. Saied, A. Elkholy, S. F. Hafez et al., “Antimicrobial resistance in pathogens causing nosocomial bloodstream infections in university hospitals in Egypt,” American Journal of Infection Control, vol. 39, no. 9, pp. e61–e65, 2011.
[3]
J. Trostle, “Inappropriate distribution of medicines by professionals in developing countries,” Social Science and Medicine, vol. 42, no. 8, pp. 1117–1120, 1996.
[4]
S. Q. Nizami, I. A. Khan, and Z. A. Bhutta, “Differences in self-reported and observed prescribing practice of general practitioners and paediatricians for acute watery diarrhoea in children of Karachi, Pakistan,” Journal of Diarrhoeal Diseases Research, vol. 13, no. 1, pp. 29–32, 1995.
[5]
S. Q. Nizami, I. A. Khan, and Z. A. Bhutta, “Self-reported concepts about oral rehydration solution, drug prescribing and reasons for prescribing antidiarrhoeals for acute watery diarrhoea in children,” Tropical Doctor, vol. 26, no. 4, pp. 180–183, 1996.
[6]
S. Q. Nizami, Z. A. Bhutta, and A. M. Molla, “Efficacy of traditional rice-lentil-yogurt diet, lactose free milk protein-based formula and soy protein formula in management of secondary lactose intolerance with acute childhood diarrhoea,” Journal of Tropical Pediatrics, vol. 42, no. 3, pp. 133–137, 1996.
[7]
K. E. Arnold, R. J. Leggiadro, R. F. Breiman et al., “Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee,” Journal of Pediatrics, vol. 128, no. 6, pp. 757–764, 1996.
[8]
A. G. Mainous III, W. J. Hueston, and J. R. Clark, “Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold?” Journal of Family Practice, vol. 42, no. 4, pp. 357–361, 1996.
[9]
A. G. Mainous III and W. J. Hueston, “The cost of antibiotics in treating upper respiratory tract infections in a medicaid population,” Archives of Family Medicine, vol. 7, no. 1, pp. 45–49, 1998.
[10]
Z. Grossman, S. del Torso, A. Hadjipanayis, D. van Esso, A. Drabik, and M. Sharland, “Antibiotic prescribing for upper respiratory infections: European primary paediatricians' knowledge, attitudes and practice,” Acta Paediatrica, vol. 101, no. 9, pp. 935–940, 2012.
[11]
S. Huilan, L. G. Zhen, M. M. Mathan et al., “Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries,” Bulletin of the World Health Organization, vol. 69, no. 5, pp. 549–555, 1991.
[12]
Z. A. Bhutta, “Therapeutic aspects of typhoidal salmonellosis in childhood: the Karachi experience,” Annals of Tropical Paediatrics, vol. 16, no. 4, pp. 299–306, 1996.
[13]
E. R. Levy, S. Swami, S. G. Dubois, R. Wendt, and R. Banerjee, “Rates and appropriateness of antimicrobial prescribing at an academic children's hospital, 2007–2010,” Infection Control and Hospital Epidemiology, vol. 33, no. 4, pp. 346–353, 2012.
