Irrational antibiotic prescribing practice among children in critical care of tertiary hospitals

Abstract

This study assessed the prescribing pattern of irrational use of antibiotic among children under age of 12 years in public and private sector hospitals in Pakistan. The prospective clinical evaluation of drug utilization pattern of antimicrobials from Patient Bedside File (PBF) of in-patients and Culture Sensitivity Test (CST) reports were evaluated to determine the antibiotic resistance. Two indicators recorded to assess antibiotic prescribing were; dose of prescribed antibiotic (low-dose, rational and high -dose) and Indication (valid or invalid). Antibiotics resistance for 25 selected antibiotics was determined by culture sensitivity test. This study showed that in Private Sector Hospital 77.7% neonates, 13.3% infants and 9% children admitted in ICU were receiving antibiotics, among them only 57.3% neontes, 62% infants and 59.9% children were found valid that is prescribed antibiotics for right indication. 27% neonates, 19% infants and 22.1% children were prescribed under dose of antibiotics, which may lead to antimicrobial resistance and increased cost of hospital stay. Only 29.1% neonates, 30% infants and 36.8% children were receiving rational dosing. In Public Sector Hospital, 65.6% neonates, 19.4% infants and 15% children were receiving antibiotics. Among them valid indication was found in 35.3% neonates, 35.6% infants and 39.8% in children. 33.3% neonates, 26.6% infants and 28.2% children were receiving under dose that may lead to resistance not only among those who were prescribed under dose but also such bacteria become resistant and spread to other population to increase antimicrobial resistance. The irrational prescribing of antibiotics was found very high (above 50%) in Public sector hospital (Hospital-B) for every age group whereas in Private sector hospital (Hospital-A) this practice was found near to 50%. In this study the prescribing frequency of Amikacin, Cefixime, Cefotaxime, Meropenem, Amoxicillin, Vancomycin, Azithromycin, Levofloxacin and Clarithromycin was found above 80% in both hospitals (A and B). Among these, Amoxicillin, Penicillin, Erythromycin and Cephalexin showed higher resistance i.e. 49.2%.