Assessment and evaluation of rational use of antibiotics in pediatric population at a tertiary care hospital

Kasa Kavya Dharani; Banjara Raju Prabhudev; Balakeshwa Ramaiah

doi:10.18203/2319-2003.ijbcp20263785

Authors

Kasa Kavya Dharani Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
Banjara Raju Prabhudev Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
Balakeshwa Ramaiah Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20263785

Keywords:

Antibiotic use, Paediatric inpatients, Antimicrobial stewardship, Antibiotic appropriateness, Antimicrobial resistance

Abstract

Background: Rational antibiotic use in paediatric patients is essential to optimize treatment outcomes and minimize adverse effects. Inappropriate prescribing may result in treatment failure, toxicity, and antimicrobial resistance.

The objectives are to assess antibiotic prescribing patterns, evaluate appropriateness, describe culture and susceptibility findings, and assess antibiotic optimization among paediatric inpatients in a tertiary care hospital.

Methods: A prospective observational study was conducted among 250 paediatric inpatients aged below 18 years who received at least one systemic antibiotic for suspected or confirmed infection. Data were collected from case notes, medication charts, and laboratory reports. Appropriateness was assessed according to the hospital antibiotic policy, and culture and susceptibility results were reviewed.

Results: Toddlers (39.2%) and children (36.4%) constituted the largest age groups, while males accounted for 53.6% of participants. Respiratory tract infections were the predominant indication (44.7%). Among 414 antibiotics prescribed, ceftriaxone (28.5%), azithromycin (18.8%), and amoxicillin-clavulanate (17.1%) were most frequently used. Intravenous administration accounted for 71.49% of prescriptions. Overall, 98% of prescriptions were appropriate, 0.8% inappropriate, and 1.2% not assessable. Watch antibiotics constituted 64% of use. Four mild, probable adverse drug reactions were reported. Escherichia coli was the most frequently isolated organism, with 91.3% susceptibility to imipenem.

Conclusions: Antibiotic prescribing was generally appropriate; however, the high use of Watch antibiotics emphasizes regular prescription review, culture-guided therapy, adherence to hospital guidelines, and continued antimicrobial stewardship.

Author Biographies

Banjara Raju Prabhudev, Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India

Assistant Professor, Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India.

Balakeshwa Ramaiah, Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India

Head of the Department, Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India.

References

Karageorgos S, Hibberd O, Mullally PJW, Segura-Retana R, Soyer S, Hall D. Antibiotic use for common infections in pediatric emergency departments: a narrative review. Antibiotics (Basel). 2023;12(7):1092.

Sheikh S, Saleem Z, Afzal S, Qamar MU, Raza AA, Haider Naqvi SZ, et al. Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. Front Pediatr. 2024;12:1469766.

Al Balushi KA, Al-Sawafi F, Al-Ghafri F, Al-Zakwani I. Drug utilization pattern in an Omani pediatric population. J Basic Clin Pharm. 2013;4(3):68-72.

Aldabagh A, Abu Farha R, Karout S, Itani R, Abu Hammour K, Alefishat E. Evaluation of drug use pattern in pediatric outpatient clinics in a tertiary teaching hospital using WHO drug-prescribing indicators. J Multidiscip Healthc. 2022;15:1143-51.

Yang HM, Wang YP, Liu YL, Shamsi BH, Bo H, Meng XC. Analysis of distribution and antibiotic resistance of pathogens isolated from the paediatric population in Shenmu Hospital from 2011-2015. J Int Med Res. 2018;46(1):225-33.

Autore G, Bernardi L, Ghidini F, La Scola C, Berardi A, Biasucci G, et al. Antibiotic prophylaxis for the prevention of urinary tract infections in children: guideline and recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group. Antibiotics (Basel). 2023;12(6):1040.

Khan A, Jhaveri R, Seed PC, Arshad M. Update on associated risk factors, diagnosis, and management of recurrent urinary tract infections in children. J Pediatric Infect Dis Soc. 2019;8(2):152-9.

Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary tract infection in children. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):2-18.

Madhi F, Panetta L, De Pontual L, Biscardi S, Remus N, Gillet Y, et al. Antimicrobial treatment of lower respiratory tract infections in children. Infect Dis Now. 2023;53(8):104782.

Zec SL, Selmanovic K, Andrijic NL, Kadic A, Zecevic L, Zunic L. Evaluation of drug treatment of bronchopneumonia at the pediatric clinic in Sarajevo. Med Arch. 2016;70(3):177-81.

Quaak CH, Cové E, Driessen GJ, Tramper-Stranders GA. Trends in paediatric inpatient antibiotic therapy in a secondary care setting. Eur J Pediatr. 2018;177(8):1271-8.

Garedow AW, Tesfaye GT. Evaluation of antibiotics use and its predictors at pediatrics ward of Jimma Medical Center: hospital based prospective cross-sectional study. Infect Drug Resist. 2022;15:5365-75.

Hu X, Zhang X, Wang Y, Xie X. Cross-sectional study on the drug utilization and evaluation indicator of antibiotics used in pediatric population. BMC Health Serv Res. 2021;21:1091.

Brembilla A, Mauny F, Garcia A, Koura KG, Deloron P, Faucher JF. Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study. Eur J Clin Microbiol Infect Dis. 2016;35(4):681-9.

Jeeyani HN, Parikh RH, Sivanandan S, Muliya HJ, Badiyani SN, Patel MB. Study of antimicrobial use in paediatric inpatients in a tertiary care hospital in Ahmedabad, India. Int J Contemp Pediatr. 2021;8(1):35-40.

Esposito S, Biasucci G, Pasini A, Predieri B, Vergine G, Crisafi A, et al. Antibiotic resistance in paediatric febrile urinary tract infections. J Glob Antimicrob Resist. 2022;29:499-506.

Vachvanichsanong P, McNeil EB, Dissaneewate P. Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections. Epidemiol Infect. 2020;149:e12.

Pernica JM, Harman S, Kam AJ, Carciumaru R, Vanniyasingam T, Crawford T, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: the SAFER randomized clinical trial. JAMA Pediatr. 2021;175(5):475-82.

Zaoutis T, Shaikh N, Fisher BT, Coffin S, Bhatnagar S, Downes KJ, et al. Short-course therapy for urinary tract infections in children: the SCOUT randomized clinical trial. JAMA Pediatr. 2023;177(8):782-9.

Vazouras K, Jackson C, Folgori L, Anastasiou-Katsiardani A, Hsia Y, Basmaci R. Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children. BMC Infect Dis. 2023;23:400.

Yehualaw A, Taferre C, Bantie AT, Demsie DG. Appropriateness and pattern of antibiotic prescription in pediatric patients at Adigart General Hospital, Tigray, Ethiopia. Biomed Res Int. 2021;2021:6640892.

Murthy SN, Jose PV, Basalingappa S, Ali SK, Elizabeth MVK. Adverse drug reactions in hospitalized paediatric patients in a tertiary care center in Kerala, India. Int J Basic Clin Pharmacol. 2018;7(10):1998-2004.

Kurma VR, Manchu T, Amancharla MK, Manchu K, Kandula PK. Pattern of adverse drug reactions in paediatric patients reported to adverse drug reaction monitoring centre in a tertiary care hospital. Int J Contemp Pediatr. 2019;6(4):1557-62.

Nasso C, Scarfone A, Pirrotta I, Rottura M, Giorgi DA, Pallio G, et al. Appropriateness of antibiotic prescribing in hospitalized children: a focus on the real-world scenario of the different paediatric subspecialties. Front Pharmacol. 2022;13:890398.

Arnolda G, Hibbert P, Ting HP, Molloy C, Wiles L, Warwick M, et al. Assessing the appropriateness of paediatric antibiotic overuse in Australian children: a population-based sample survey. BMC Pediatr. 2020;20:185.

Kamara IF, Fofanah BD, Nuwagira I, Kamara KN, Tengbe SM, Abiri O, et al. Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study. Antimicrob Resist Infect Control. 2024;13:80.

Koçak M, Büyükkaragöz B, Çelebi Tayfur A, Çaltik A, Köksoy AY, Çizmeci Z, et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int. 2016;58(6):467-71.

Priyadharsini R, Surendiran A, Adithan C, Sreenivasan S, Sahoo FK. A study of adverse drug reactions in pediatric patients. J Pharmacol Pharmacother. 2011;2(4):277-80.

Islam AFM, Raihan MA, Ahmed KT, Islam MS, Nusrat NA, Hasan MA, et al. Prevalence of inappropriate antibiotic doses among pediatric patients of inpatient, outpatient, and emergency care units in Bangladesh: a cross-sectional study. PLOS Glob Public Health. 2024;4(9):e0003657.