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Rational use of antimicrobials in infants in primary care of Bahrain
Khalid A J Al Khaja1, Thuraya M Al-Ansari, Awatif H H Damanhori
1Department of Pharmacology & Therapeutics, Arabian Gulf University, Kingdom of Bahrain. khlidj@agu.edu.bh
Insights
Antimicrobial prescribing errors, including incorrect dosages, are common in infants. Healthcare providers need better strategies to ensure safe and effective antimicrobial use in pediatrics.
Area of Science:
- Pediatric Pharmacology
- Infectious Disease Management
- Primary Healthcare Research
Background:
- Antimicrobial prescribing patterns in infants are crucial for effective treatment and resistance prevention.
- Previous studies highlight variations in pediatric antimicrobial use, necessitating localized data.
Purpose of the Study:
- To evaluate antimicrobial prescribing practices for infants in Bahrain's primary care settings.
- To identify and analyze prescribing errors in pediatric antimicrobial prescriptions.
Main Methods:
- A nationwide, prescription-based study conducted in 20 primary care health centers in Bahrain.
- Data collection by pharmacists in May 2004, focusing on infant prescriptions.
- Analysis of antimicrobial drug classes, dosages, frequencies, and durations.
Main Results:
- Antimicrobials were the 5th most common drug class prescribed to infants (23.8%), with beta-lactams predominating.
- Subtherapeutic doses were administered to 22% of infants, and errors were frequent in dosage, strength, and frequency.
- Prescribing errors were significantly correlated with infant age for certain antimicrobials, indicating inadequate dosage adjustments.
Conclusions:
- Overt antimicrobial use and prescription errors in infants are prevalent in primary care.
- Inadequate attention is paid to age-appropriate antimicrobial dosage adjustments for infants.
- Urgent need for strategies to enhance prescription writing skills among healthcare providers for pediatric patients.
Abstract:
This nationwide prescription-based study was undertaken to evaluate antimicrobial prescribing for infants, and to identify prescribing errors in infants in 20 primary care health centres of Bahrain. Data was collected on a daily basis by pharmacists in May 2004. Antimicrobials ranked the 5th most common drugs prescribed in infants; beta-lactams, notably amoxycillin and cephalexin, comprised 81.6% of overall prescribed antimicrobials. Antimicrobials were prescribed to approximately one out of four infants (23.8%), prescribed more often to infants aged 9-12 months of age. Approximately one-fifth (22%) of infants received antimicrobials at subtherapeutic daily doses. The prescribing errors were related to dosage (39.2%), strength/doses (26.4%), frequency of dosing (19.2%), and duration of therapy (4.5%). Antimicrobial dosage prescribed in relation to infants' age revealed a positive correlation for amoxycillin (r = 0.264; p < 0.0001), cephalexin (r = 0.223; p = 0.029), erythromycin (r = 0.127; p = 0.284), and a negative correlation for metronidazole (r = -0.183; p = 0.415). Overt use of antimicrobials in infants, and prescription-writing errors (in dosages and frequency of dosing) were common in primary care. Dosage adjustment in relation to developmental stages of infants has received inadequate attention. Effective strategies to improve prescription writing skills are urgently required.
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