Prescription pattern of antimicrobial drugs in pediatrics outpatient department of a tertiary care teaching hospital of North India

Hitesh Mishra, Rajeev Mishra, Arka Mondal


Background: The pediatric population comprises of 20-25% of the total world population, and numerous acute and chronic diseases can effect this sub population. Antibiotics are among the most frequently prescribed classes of medications for children.

Methods: The study is prospective interventional study carried out in the pediatric outpatient of the MIMS for a period of 3 months (September-November 2013+1 month for analysis).

Results: Most (84%) children were given single antimicrobial agent and 16% were given more than one antimicrobial or fixed dose combination of the antimicrobial agent. Amoxicillin (48%), erythromycin (20%) and cefixime (16%) were found to be the most frequently used antibiotics.

Conclusions: The high percentage of prescriptions involving antimicrobials observed in MIMS requires rational use of antimicrobials and judicious prescribing. It should be followed by the appropriate use of the selected medicine from the NLEM with frequent update of information. The implementation of antibiotic policy and treatment guidelines with periodic assessment of the clinical pharmacologist in the study area is very important in order to monitor the clinical use of these medications.


Antibiotics, Pediatric patients

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Ferris TG, Saglam D, Stafford RS, Causino N, Starfield B, Culpepper L, et al. Changes in the daily practice of primary care for children. Arch Pediatr Adolesc Med. 1998;152(3):227-33. [DOI via Crossref]

McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002;287(23):3096-102. [DOI via Crossref]

McCaig LF, Besser RE, Hughes JM. Antimicrobial drug prescription in ambulatory care settings, United States, 1992–2000. Emerg Infect Dis. 2003;9(4):432-7. [DOI via Crossref]

Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279(11):875-7. [DOI via Crossref]

Ansam S, Ghada AB, Laila A, Waleed S, Rowa AR, Nidal J. Pattern of parenteral antimicrobial prescription among pediatric patients in Al-Watani Government Hospital in Palestina. An-Najah Univ J Res. (Nat Sci) 2006;20:191-206.

Jha V, Abid M, Mohanata GP, Patra A, Kishore K, Khan NA. Assessment of antimicrobials use in pediatrics in Moradabad city. Indian J Pharm Pract. 2010;3(1):19-24.

Arulmoli SK, Sivachandiran S, Perera BJC. Prescribing patterns of antibiotics for children before admission to a paediatric ward in Jaffna Teaching Hospital. Sri Lanka J Child Health. 2009;38:121-3. [DOI via Crossref]

Ramanath KV, Balaji BVB. Study the outpatients prescription pattern of antibiotics in paediatric populations of two hospitals. Arch Pharm Pract. 2013;4(1):21-7. [DOI via Crossref]

Schappert SM. National Ambulatory Medical Care Survey: 1992 Summary. Hyattsville, MD: National Center for Health Statistics; 1994. Advance Data from Vital and Health Statistics No. 253.

Sanz EJ, Bergman U, Dahlstorm M. Paediatric drug prescribing. Eur J Clin Pharmacol. 1989;37:65-8.

Fisher BT, Meaney PA, Shah SS, Irwin SA, Grady CA, Kurup S, et al. Antibiotic use in paediatric patients admitted to a referral hospital in Botswana. Am J Trop Med Hyg. 2009;81(1):129-31.

WHO. The Management of Acute Respiratory Infections in Children, Practical Guidelines for Outpatient Care. Geneva: World Health Organisation; 1995.

Ciofi Degli Atti ML, Raponi M, Tozzi AE, Ciliento G, Ceradini J, Langiano T. Prevalence study of antibiotic use in a pediatric Hospital in Italy. Euro Surveill. 2008;13(41):Pii: 19003.

Jimoh AO, Etuk EU, Sani Z, Shuaibu HA. The pattern of antibiotic use in a family medicine department of a tertiary hospital in Sokoto, North Western Nigeria. J Clin Diagn Res. 2011;5(3):566-9.

Kumar J, Shaik MM, Kathi MC, Deka A, Gambhir SS. Prescribing indicators and pattern of use of antibiotics among medical outpatients in a Teaching Hospital of Central Nepal. J Coll Med Sci Nepal. 2010;6(2):7-13. [DOI via Crossref]

Woldu MA, Suleman S, Workneh N, Berhane H. Retrospective study of the pattern of antibiotic use in Hawassa University Referral Hospital Pediatric Ward, Southern Ethiopia. J App Pharm Sci. 2013;3(02):093-8.

WHO. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators. Geneva: World Health Organization; 1993.

WHO. Teacher's Guide to Good Prescribing. Geneva: World Health Organization; 2001. WHO/EDM/PAR/2001.

WHO. Guideline on Antimicrobial Use for Primary Health Care Clinics. Geneva: WHO; 2002.

Lim VK, Suleiman AB. Pattern of antibiotic usage in Hospitals in Malaysia. Singapore Med J. 1993;34:525-8.

Schllenberg E, Albritton WL. Antibiotic misuse in a paediatric teaching hospital. Can Med Assoc J. 1980;122:49-52.

da Cunha AJ, Amaral J, E Silva MA. Inappropriate antibiotic prescription to children with acute respiratory infection in Brazil. Indian Pediatr. 2003;40:7-12.