Irrational Prescribing of Antibiotics in Pediatric Outpatients: A Need for Change

Year 2015, Volume: 7 , - , 07.01.2015

Edita Alili-ıdrizi Merita Dauti Ledjan Malaj

Abstract

Background and Aims: Antibiotics play a major role in the treatment of infectious diseases and are among the drugs most commonly prescribed for children. Respiratory tract infections in pediatric patients are a common cause of antibiotic prescribing which increases morbidity, mortality, patient cost and the likelihood for emergence of antibiotics-resistant microorganisms. This study was undertaken to determine the proportion of common respiratory tract infections and to generate data on the extent of rational/irrational prescribing of antibiotics in patients attending the pediatric out-patient department. Material and Methods: retrospective study carried out during one year (January to December, 2013) in the pediatric out-patient department of the Clinical Center in Tetovo. Patients of either sex at age group between 1 week and 14 years who attended the pediatric out-patient department and were prescribed antibiotics for respiratory tract infections were included in the study. The data was compared against national guideline-based medicine, major antibiotic guidelines recommended by World Health Organization (WHO) and American Academy of Pediatrics (AAP), and cross-referenced against Cochrane studies. Results: Children aged >1 - ≤3 years received 49.6% of antibiotics. The most common prescribed antibiotics were penicillins (62.2%), followed by cephalosporins (32.5%). Sore throat (61.5%) was identified as the most common diagnosis. There was a significant relationship (r=0.234, p< 0.05) between diagnosis and antibiotic prescribing. Ninety two percent of pediatric patients with common cold, laryngitis, viral sore throat, acute otitis media and bronchitis were prescribed antibiotics irrationally, that represents a major deviation from the recommendations from the guidelines. High levels (90%) of antibiotic irrational prescribing were revealed in pediatric outpatients diagnosed with pneumonia. Conclusion: This study reinforces the need to implement strategies that promote rational use of antibiotics in respiratory tract infections in children and close monitoring of antibacterial use at national, regional and local level.

Keywords

Antibiotics, irrational prescribing, pediatric outpatients

References

• 1- Arulmoli SK, Sivachandiran S, Perera BJC. Prescribing Patterns of Antibiotics for Children before Admission to a Paediatric Wardin Jaffna Teaching Hospital, Sri Lanka. J Child Health. 2009; 38:121-123.
• 2- Bharathiraja R, Sridharan S, Chelliah LR, Suresh S, Senguttuvan. Factors affecting antibiotic prescribing pattern in paediatric practice. Indian J Paediatric 2005; 72:877-80. 3- Trostle
• J.Inappropriate distribution of
• medicines by professionals in developing
• countries. Soc Sci Med. 1996;42:1117–1120.
• 4- Christakis DA, Rivara FP. Pediatrician’s awareness and attitudes about four clinical practice 101:825-830 Pediatrics. 1998;
• 5- Centers for Disease Control and Prevention. Get Smart: pediatric treatment guidelines for URIs. www.cdc.gov/getsmart/campaign- materials/pediatric-treatment.html. at:
• 6- Centers for Disease Control and Prevention. A public health action plan to combat antimicrobial www.cdc.gov/drugresistance/actionplan/actio nplan.html. Available at:
• 7- Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd edition. Geneva: World Health Organization; 2013. Available from: http://www.ncbi.nlm.nih.gov/books/NBK154 447/
• 8- Adam L, Hersh AL, Jackson MA, Hicks LA and the Committee on Infectious Diseases. Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory. Pediatrics. 2013;132:1146-1154
• 9- Pelucchi C, Grigoryan L, Galeone C, Esposito S, P. Huovinen P, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012; 18 (Suppl. 1): 1–27
• 10- Wannamaker LW. Perplexity and precision in the diagnosis of streptococcal pharyngitis. Am J Dis Child. 1972; 124:352–8.
• 11- Breese BB. A simple scorecard for the tentative pharyngitis. Am J Dis Child.1977; 131:514–7 of streptococcal
• 12- McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291:1587–95.
• 13- Poses RM, Cebul RD, Collins M, Fager SS. The accuracy of experienced physicians’ probability estimates for patients with sore throats, implications for decision making. JAMA 1985; 254:925–9.
• 14- Hayden GF, Turner RB. Acute Pharyngitis. In: Nelson WE, Behrman RE, Kliegman RM, Marvin AM, eds. Nelson textbook of pediatrics, 19th ed. Philadelphia, Saunders; 2011:1439-1440
• 15- Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86- 102.
• 16- Muszynski MJ, Marks M I. Epiglottitis, Laryngitis, and Croup. In: Schlossberg D, ed. Infections of the Head and Neck. New York, Springer-Verlag; 1987:133-147
• 17- Rovers MM, Schilder AG, Zielhuis GA, et al. Otitis media. Lancet 2004; 363: 465–73.
• 18- Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131:964–99.
• 19- Goodman DM. Bronchitis. In: Nelson WE, Behrman RE, Kliegman RM, Marvin AM, eds. Nelson textbook of pediatrics, 19th ed. Philadelphia, Saunders; 2011:1459 20- 20.
• Sandora TJ, Sectish TC. Community
• Acquired Pneumonia. In: In: Nelson WE,
• Behrman RE, Kliegman RM, Marvin AM,
• eds. Nelson textbook of pediatrics, 19th ed.
• Philadelphia, Saunders; 2011:1474-1478 21- McIntosh K. Community-acquired
• pneumonia in children. N Engl J Med. 2002; 346: 429-437.
• 22- Shoham Y, Dagan R, Givon-Lavi N, Liss Z, Shagan T, et al. Community-acquired pneumonia in children: quantifying the burden on patients and their families including decrease in quality of life. Pediatrics. 2005; 115: 1213-1219.
• 23- Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The Management Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:e25-76 Community-Acquired
• 24- Hashemi S, Nasrollah A, Rajabi M. Irrational antibiotic prescribing: a local issue or global concern? EXCLI Journal. 2013;12:384-395
• 25- Murphy M, Bradley CP, Byrne S. Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing -an Irish 2012;13:43. BMC Fam Pract.
• 26- Wang EL, Einarson TR, Kellner JD, Conly JM. Antibiotic prescribing for canadian preschool overprescribing Infections. CID. 1999;29:155–60 of viral respiratoriy
• 27- Mungrue K, Brown T, Hayes I, Ramroop S, Thurston P, Pereira LP. Drugs in upper respiratory tract infections in paediatric patients in North Trinidad. Pharm Pract. 2009; 7(1):29-33
• 28- Bisno AL, Gerber MA, Jack M, Gwaltney JM Jr., Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis.CID 2002; 35:113–25
• 29- Fossum GH, Lindbæk M, Gjelstad S, et al. Are children carrying the burden of broad- spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway. BMJ Open 2013;3:e002285.
• 30- Schwartz B, Marcy M, Phillips WR, Gerber MA, Dowell SF. Otitis Media -Principles of Judicious Use of Antimicrobial Agents. Pediatrics 1998;101(1):165-171.
• 31- Morris PS, Leach AJ. Acute and Chronic Otitis Media. Pediatr Clin N Am. 2009; 56:1383–1399
• 32- Centre for Clinical Practice at NICE (UK). Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care. London: National Institute for Health and Clinical Excellence (UK); 2008 Jul. (NICE Clinical Guidelines, No. 69.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK536 32/
• 33- Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2006;(4):CD000023.
• 34- Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane 2005;(3):CD000247. Syst Rev
• 35- Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2004;(1):CD000219
• 36- Dorj G, Hendrie D, Parsons R, Sunderland B. An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia. BMC Health Serv Res. 2013; 13:379
• 37- Gwimile JJ, Shekalaghe SA, Kapanda GN, Kisanga ER. Antibiotic prescribing practice in management of cough and/or diarrhoea in Moshi Municipality, Northern Tanania: cross-sectional descriptive study. Pan Afr Med J.2012;12:103
• 38- Mishra H, Mishra R, Mondal A. Prescription pattern of antimicrobial drugs in pediatrics outpatient department of a tertiary care teaching hospital of North India. Int J Basic Clin Pharmacol. 2014; 3(2): 385-388.
• 39- MacFarlane J, Lewis SA, MacFarlane R, Holmes W. Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U. K.: implications for developing management 1997;91:427–34. Resp Med.
• 40- Bain J. Justification for antibiotic use in general practice. BMJ. 1990;300:1006–7.
• 41- Schwartz RH, Freij BJ, Ziai M, Sheridan MJ. Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners. Pediatr Infect Dis J. 1997;16:185–90.
• 42- Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Pract. 1993;37:23–7.