Utilization of Antibiotics Among Pediatrics Visiting A Nigerian Hospital
Utilization of Antibiotics Among Pediatrics Visiting A Nigerian Hospital.
ABSTRACT
World Health Organization(WHO) established indicators to measure quality and pattern of use of drugs especially in low resource settings. Utilization of antibiotics among children in developing countries has not been fully studied. To evaluate the quality and pattern of use of antibiotics among children in a Nigerian referral hospital and to assess prescription quality compliance with WHO prescribing indicators.
Folders and prescriptions of children from 2010 to 2011 in Enugu State University of Technology Teaching Hospital were randomly sampled. Prescriptions with antibiotics or at least an infection were sorted, coded and entered into the SPSS version 16 for stasitical analysis.
Descriptive and inferential analyses (prediction using logistic regression) were conducted using patients’ demographic data, prescribed drugs and their cost. Cephalosporins were the most prescribed antibiotics and the mean (SD) number of antibiotics per prescription visit was 1.21(0.44) with nearly 45% of the children receiving antibiotics as injections.
Only 27% of the drugs were prescribed as generics and only about 58.3% were listed on the essential drugs list. Broad spectrum antibiotics were mostly prescribed (50.4%), as they increased from 2010 to 2011 specifically driven by factors such as higher cost of the antibiotic (p<0.001), high cost of other drugs (p<0.001), not being listed on the EDL (P<0.001) and being an injection (p<0.001).
Cost/DDD showed cephalosporins as the most costly antibiotic compared to other antibiotics with ten antibiotics making up the DU90%. Utilization of antibiotics in this hospital was not excessive but not in compliance with WHO guidelines. The use trend analysis of broad spectrum agents was on the increase over the years under study and should be handled with caution so as to preserve the therapeutic life of these antibiotics.
INTRODUCTION
Antibiotics are prescription medications and therefore are subject to strict regulatory control in their distribution. Reports worldwide suggest that the prescription of antibiotics is declining in certain developed regions but there has been a consequent increase in the use of expensive and broad spectrum antibiotics. Inappropriate use of antibiotics in sub-Saharan Africa has been put at half the entire prescriptions given.
In general practice, antibiotics usage is highest among children, yet this group of patients represent a large reservoir for resistant organisms. The inevitable consequence of the widespread use of antimicrobial agents has been the emergence of antibiotic-resistant pathogens, fueling an ever need for new drugs.
Considering their potent actions when used and serious side effects when misused, their use in population such as in pediatrics needs a consistent and persistent monitoring to ensure their proper use in such a delicate group. Appropriate use of antibiotics can slow down the emergence of resistance amongst these drugs. Numerous guidelines with national to regional to worldwide coverage have been introduced to efficiently promote the use of antibiotics.
However in recent years, low- income countries including Nigeria, have experienced accelerating antibiotic resistance and rapid spread of multi-resistant strains of many pathogens. These are included in other challenges such as a higher worldwide share of infectious diseases, paucity of qualified and competent health care professionals, widespread self medication and lack of access to newer antimicrobial agents.
Statement of Problem
Utilization of antibiotics among children in hospitals or community settings is an area of research sparsely conducted in Africa. Numerous studies on the use pattern and cost effectiveness of antibiotics have been/and are still being conducted in other regions of the world.
With antibiotics still accounting for majority of the drugs prescribed in majority of children and most of the infections commonly found in children are viral in nature, it is therefore unlikely that infected children would benefit from such treatments.
This practice may trigger overuse or misuse of antibiotics which contributes to the global problem of antibiotic over prescribing. Some studies have shown decreasing antibiotic prescription among children but still with increasing incidence of resistance.
REFERENCES
Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescription in pediatrics in the United States. Pediatrics 2011; 128: 1053-1061
Holloway KA, Ivanovska V, Ross-Degnan D et Medicines use in primary care in developing and transitional countries. WHO, Geneva. 2009
Majeed A and Moser Age- and sex-specific antibiotic prescribing patterns in general practice in England and Wales in 1996. British Journal of General Practice 2009; 49: 735-736
Klugman KP. Pneumococcal resistance to antibiotics. Clinical Microbiology Reviews 1990; 3: 171-196
Chambers H. Antimcrobial agents-General considerations. In: Goodman and Gilman’s The Pharmacological basis of Hardman JG and Limbird AG (eds), 10th edn. McGrawHill, NewYork 2001; pp 1143-1170.
CSN Team.
