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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 235-237

Assessment of antibiotic prescribing pattern in pediatric patients: A cross-sectional hospital-based survey


1 Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Anantapur, Andhra Pradesh, India
2 Department of Pharmaceutical Analysis, Raghavendra Institute of Pharmaceutical Education and Research, Anantapur, Andhra Pradesh, India
3 Department of Pediatrics, RD Trust Hospital, Bathalapalli, Andhra Pradesh, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Bhupalam Pradeepkumar
Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, KR Palli Cross, Chiyyedu Post, Anantapur - 515 721, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_52_17

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  Abstract 

Background: Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality, and economic burden for health care. India is a lower-middle income developing country in south Asia that has high potential for overuse and misuse of antibiotics and has less public awareness of antimicrobial resistance. The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics. Aim: The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh, India. Subjects and Methods: A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district. Sample size was calculated using single population proportion formula. A total number of 845 pediatric in-patients were included for the study. Patients' demographic characters, diagnosis, and drugs prescribed were recorded in a prestructured and validated data collection form. Results: An average of 3.53 drugs prescribed per patient encounter, which was higher than WHO prescribed indicator standard value 2. The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Among 423 antibiotic prescriptions, 23.43% (198) prescribed with generic names and 91.48% antibiotics were prescribed from essential drug formulary list. Conclusion: Prescription patterns and usage of antibiotics in this study was inappropriate in comparing our results with WHO prescribing indicators. Effective interventions are required to reduce inappropriate antibiotic prescriptions.

Keywords: Antibiotics, antimicrobial resistance, pediatrics, prescribing pattern, World Health Organization prescribing indicators


How to cite this article:
Pradeepkumar B, Alameri T, Narayana G, Reddy Y P, Ramaiah JD. Assessment of antibiotic prescribing pattern in pediatric patients: A cross-sectional hospital-based survey. CHRISMED J Health Res 2017;4:235-7

How to cite this URL:
Pradeepkumar B, Alameri T, Narayana G, Reddy Y P, Ramaiah JD. Assessment of antibiotic prescribing pattern in pediatric patients: A cross-sectional hospital-based survey. CHRISMED J Health Res [serial online] 2017 [cited 2017 Dec 17];4:235-7. Available from: http://www.cjhr.org/text.asp?2017/4/4/235/216479


  Introduction Top


Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality and economic burden on health-care services.[1],[2],[3] India is a lower-middle income developing country in south Asia which have high potential for overuse and misuse of antibiotics and have less public awareness of antimicrobial resistance.[4],[5] The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics.[6] The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh (AP), India.


  Subjects and Methods Top


The study protocol was submitted to the Raghavendra Institute of Pharmaceutical Education and Research Institutional Review Board (IRB). The study was initiated after ethical clearance from IRB with the approval number: RIPER/IRB/2017/016. The required sample size was calculated by Epi-info 7 for Dos version 3.5.1 software (Centers for Disease Control and Prevention, Clifton Road, Atlanta, USA) using single population proportion formula with assumption of confidence interval 95%, margin of error 5%, 50% prevalence of antibiotics use, design effect 2%, and nonresponse rate 10%. Considering with the above assumption, the sample size became 768. Finally, 10% of the determined sample was added to compensate the nonresponse rate and the sample size was found to be 845. Pediatric patients of both gender <12 years of age were included in the study. Critically, ill patients and outpatients were excluded from the study. The data were collected through direct interview with patient parent or guardian. A structured and validated data collection form was used for data collection with the help of medical records, prescription charts, and laboratory records. A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district, AP, India. The study was carried out in six hospitals including Rural Development Trust Hospital, Bathalapalli. The study was conducted for 3 months during January to March 2017. Patients' demographic characters (age, gender), diagnosis, and antibiotics prescribed were recorded. Class of antibiotic, dose, route of drug administration, frequency and duration of treatment were recorded in data collection form. Based on this collected data, average number of drugs prescribed per patient encounter, percentage of encounters with an antibiotic prescribed, percentage of antibiotics prescribed by generic name, and percentage of antibiotics prescribed from essential drugs list or formulary. The collected data was checked for the completeness. Descriptive statistics mean, median, standard deviation (SD) was calculated using Graph Pad Prism 3.0 software (San Diego, California, USA).


  Results and Discussion Top


A total of 845 pediatric patients were reviewed during the study. All the information was collected using data collection form to assess the patient demographic characters, diagnosis, and drugs prescribed. Among 845 pediatric patients [Table 1], the highest number of patients were in age group of <1 year (29.1%) and lowest group were in 10–12 years' age group (12.7%). The mean age of pediatric patients was 4.148 years (SD = 3.674 years). The median patient age was 3. This study designates that the age group less the 1 year were more susceptible for the infectious diseases. These results were supported with previous study by Thapaliya et al. 2015 who indicated that the age group less the 1 year received antibiotics more frequently than older children.[7] Among 845 sample size, 53.7% (453) were male, similar observations were seen in Khaled et al. 2014.[8] The most prevalent diseases [Table 2] were respiratory infections (21.8%) followed by gastrointestinal infections (20.3%) and cephalosporins [Table 3] were the most frequently prescribed antibiotics (46.33%), similar results were found in the previous studies by Thapaliya et al. 2015 and Patra et al. 2011.[7],[9]
Table 1: Baseline demographics (age) of study sample (n=845)

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Table 2: Distribution of diagnoses in pediatric department

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Table 3: Distribution of antibiotics prescribed in pediatric department

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WHO prescribing indicators: average of 3.53 drugs was prescribed per patient encounter as mentioned in [Table 4]. The WHO standard value for average number of drugs prescribed per patient encounter is 2.[10] Value higher than the standard is suggestive of polypharmacy which may increase the Adverse drug reaction (ADR), nonadherence, and antibiotic microbial resistance. While our observed study value is higher than the WHO index, it is similar to the values in previously published by Siva Prasad et al. 2015.[11],[12]
Table 4: World Health Organization prescribing indicators estimated from pediatric department

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The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Previous studies reveal that Antibiotic usage in Sudan (81.3%), Nigeria (71.1%) was very high when compare with our study results.[13],[14] In higher income countries like Saudi Arabia, the value was 18.5% which was less than WHO standard value.[15]

Among 423 antibiotic prescriptions, 23.43% (198) prescriptions were prescribed with generic names. Prescribing generic medicine was suggestive, because generic medicine was very cheaper with equal potential. The use of generic names in our sample was less when compare to the countries such as Sudan (49.3%) and Nigeria (68.9%).[13],[14]

Among 423 sample size, 91.48% antibiotics were prescribed from essential drug formulary list. The formulary list helps for rational prescribing of antibiotics by cheering selection of cost-effective and appropriate to local drug resistance. The study shows high level of adherence, but better results still can be achieved like in UAE 100%.[16]


  Conclusion Top


Prescription patterns and usage of antibiotics in this study were inappropriate in comparing our results with WHO prescribing indicators. Effective interventions required to reduce inappropriate antibiotic prescriptions.

Acknowledgments

This work was supported by Raghavendra Institute of Pharmaceutical Education and Research, Anantapuramu. The authors were grateful to the management and principal of Raghavendra Institute of Pharmaceutical Education and Research for their constant support, encouragement and providing necessary facilities for this research work. The authors were grateful to the Rural Development Trust Hospital, Bathalapalli for their support for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharma S, Bowman C, Alladin-Karan B, Singh N. Antibiotic prescribing patterns in the pediatric emergency department at georgetown public hospital corporation: A retrospective chart review. BMC Infect Dis 2016;16:170.  Back to cited text no. 1
    
2.
Kebede HK, Gesesew HA, Woldehaimanot TE, Goro KK. Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia. PLoS One 2017;12:e0173290.  Back to cited text no. 2
    
3.
Mestawot F, Wubante Y, Jimma LL. Prescribing pattern of antibiotics in pediatric wards of Bishoftu Hospital, East Ethiopia. Int J Basic Clin Pharmacol 2013;2:718-22.  Back to cited text no. 3
    
4.
Wang YY, Du P, Huang F, Li DJ, Gu J, Shen FM, et al. Antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China. Int J Antimicrob Agents 2016;48:666-73.  Back to cited text no. 4
    
5.
Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013;13:1057-98.  Back to cited text no. 5
    
6.
World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug use Indicators. Geneva: WHO. Available from: http://www.apps.who.int/medicinedocs/pdf/se/se.pdf.  Back to cited text no. 6
    
7.
Thapaliya K, Shrestha S, Sheela B, Damodar B, Chaudhary RK. Prescribing pattern of antibiotics in pediatric hospital in Chitwan district in Nepal. World J Pharm Pharm Sci 2015;4:1631-41.  Back to cited text no. 7
    
8.
Khaled MA, Asif Ansari SM. Prescribing pattern of antibiotics in pediatric patients in the Jazan Region, Kingdom of Saudi Arabia. RGUHS J Pharm Sci 2014;4:120-4.  Back to cited text no. 8
    
9.
Patra S, Singh V, Pemde HK, Chandra J. Antibiotic prescribing pattern in paediatric in patients with first time wheezing. Ital J Pediatr 2011;37:40.  Back to cited text no. 9
    
10.
World Health Organization. Using Indicators to Measure Country Pharmaceutical Situations: Fact Book on WHO Level I and Level II Monitoring Indicators. Geneva: WHO. Available from: http://www.apps.who.int/medicinedocs/index/assoc/se/se.pdf.  Back to cited text no. 10
    
11.
Siva Prasad P, Thippe Rudra J, Vasanthi P, Sushitha U, Jaffar Sadiq M, Narayana G. Assessment of drug use pattern using World Health Organization core drug use indicators at Secondary Care Referral Hospital of South India. CHRISMED J Health Res 2015;2:223-8.  Back to cited text no. 11
    
12.
Sachdeva PD, Patel PG. Drug utilization studies – Scope and future perspectives. Int J Pharm Biol Res 2010;1:11-7.  Back to cited text no. 12
    
13.
Ahmed AM, Awad AI. Drug use practices at pediatric hospitals of Khartoum State, Sudan. Ann Pharmacother 2010;44:1986-93.  Back to cited text no. 13
    
14.
Fadare J, Olatunya O, Oluwayemi O, Ogundare O. Drug prescribing pattern for under-fives in a paediatric clinic in South-Western Nigeria. Ethiop J Health Sci 2015;25:73-8.  Back to cited text no. 14
    
15.
Mohajer KA, Al-Yami SM, Al-Jeraisy MI, Abolfotouh MA. Antibiotic prescribing in a pediatric emergency setting in central Saudi Arabia. Saudi Med J 2011;32:197-8.  Back to cited text no. 15
    
16.
Sharif IS, Nassar AH, Al-Hamami KF, Hassanein MM, Elmi HA, Sharif SR. Trends of pediatric outpatients prescribing in Umm Al Quwain, United Arab Emirates. Pharmacol Pharm 2015;6:9-16.  Back to cited text no. 16
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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