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Published on: February 9, 2011
Overprescribing of antibiotics to children in rural Vietnam
Mattias Larsson1, Torkel Falkenberg, Alain Dardashti
1Department of Public Health Sciences, Division of International Health (IHCAR), The Karolinska Institute, SE-171 76, Stockholm, Sweden.
Insights
Antibiotic prescribing in young children, even for common illnesses like acute respiratory tract infections, often lacks C-reactive protein (CRP) justification. This study indicates potential antibiotic overprescribing in pediatric care.
Area of Science:
- Pediatrics
- Clinical Pharmacology
- Infectious Diseases
Background:
- Antibiotic overuse is a significant global health concern.
- C-reactive protein (CRP) is a biomarker used to guide antibiotic therapy, particularly in respiratory infections.
- Assessing antibiotic prescribing patterns in pediatric populations is crucial for antimicrobial stewardship.
Purpose of the Study:
- To evaluate the relationship between antibiotic prescriptions and serum C-reactive protein (CRP) levels in children aged 1-6 years.
- To identify potential overprescribing of antibiotics in a Vietnamese healthcare setting.
- To analyze diagnoses and co-prescribed medications alongside antibiotics.
Main Methods:
- Analysis of 100 children (aged 1-6 years) who received antibiotic prescriptions.
- Comparison with a control group of 35 healthy children.
- Measurement of serum C-reactive protein (CRP) levels.
- Questionnaire interviews with caregivers regarding diagnoses and medications.
Main Results:
- Only 17% of children receiving antibiotics had elevated CRP levels (>10 mg/l).
- The most common diagnosis was acute respiratory tract infection (55%).
- Children often received multiple medications, including vitamins (77%) and corticosteroids (15%) with antibiotics.
Conclusions:
- A majority of children prescribed antibiotics based on clinical examination showed no elevated CRP levels, suggesting potential overprescribing.
- Findings highlight the need for improved diagnostic criteria and antibiotic stewardship in pediatric primary care.
- Further research should explore reasons for prescribing and patient outcomes.
Abstract:
100 children (aged 1-6 y), who received an antibiotic prescription after health examination in the Bavi health care system (79 children at a district hospital, 21 at a community health centre) were analysed regarding antibiotics prescribed in relation to serum C-reactive protein (CRP). A control group consisted of 35 healthy children. Children who had been treated with antibiotics within 1 week prior to the study were excluded in the community health centre and control groups. Capillary blood samples were collected and the serum CRP concentration was analysed. A questionnaire interview with the carers was performed. Elevated CRP concentrations (>10 mg/l) were detected in 17 (17%) of the study population, and only 2 had a CRP level above 25 mg/l, one 36 mg/l and the other 140 mg/l. In the control group, none of the children had elevated CRP. The most common diagnoses were acute respiratory tract infection (ARI, 55%), asthma (7%), tonsillitis (4%), and diarrhoea (4%). The average number of drugs per patient was 3.1, and 77% received vitamins and 15% corticosteroids in combination with antibiotics. A majority of children who received an antibiotic prescription based on clinical examination did not have an elevated CRP and overprescribing of antibiotics was thus indicated.
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