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Antimicrobial Utilization Pattern in Pediatric Patients in Tertiary Care Hospital, Eastern Ethiopia: The Need for
Samuel Girma1, Mekonnen Sisay1, Getnet Mengistu1
1School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Insights
Pediatric antimicrobial use at Hiwot Fana Hospital shows overuse of injectables, with ceftriaxone, gentamicin, and ampicillin most common. This highlights a need for antimicrobial stewardship programs to optimize drug selection and administration.
Area of Science:
- Pediatric pharmacology
- Infectious disease management
- Healthcare quality improvement
Background:
- Antimicrobials are frequently prescribed in pediatrics, but inappropriate use drives resistance and adverse outcomes.
- Understanding antimicrobial utilization patterns is crucial for effective pediatric healthcare.
- Hiwot Fana Specialized University Hospital's pediatric ward faces challenges in antimicrobial prescribing.
Purpose of the Study:
- To evaluate the patterns of antimicrobial drug utilization in a pediatric ward.
- To identify the most frequently prescribed antimicrobials and indications.
- To assess the routes of administration and documentation completeness.
Main Methods:
- A retrospective cross-sectional study analyzed 403 pediatric medical records.
- Systematic random sampling was employed for record selection.
- Data on antimicrobial prescribing were collected using a structured abstraction format.
Main Results:
- Ceftriaxone, gentamicin, and ampicillin were the most common antimicrobials; ampicillin-gentamicin combination was frequent.
- Severe pneumonia, malnutrition, and meningitis were primary indications for antimicrobial prescriptions.
- High parenteral administration (84.33%) and incomplete documentation of dosage, strength, and duration were noted.
Conclusions:
- There is an overuse of injectable antimicrobials, deviating from WHO standards.
- Polypharmacy levels are within WHO guidelines, but diagnostic support like antibiograms is absent.
- The findings strongly support the implementation of antimicrobial stewardship programs.
Abstract:
Background: Antimicrobials are among the most frequently prescribed medications for pediatric patients. However, inappropriate use of them can increase morbidity, mortality, healthcare costs, and largely antimicrobial resistance. This study aims to assess the antimicrobial utilization pattern in the pediatric ward of Hiwot Fana Specialized University Hospital. Methods: Retrospective cross-sectional study was conducted to assess the antimicrobial utilization. In this study, 403 pediatric medical records selected by systematic random sampling were reviewed. Data were collected using structured data abstraction format. Results: Ceftriaxone (n = 176, 26.5%), gentamicin (n = 125, 18.82%), and ampicillin (n = 119, 17.9%) were the most frequently prescribed antimicrobials, whereas ampicillin and gentamicin combination took the largest percentage share (n = 91, 43.3%). The most common reasons for which antimicrobials prescribed were severe pneumonia (n = 93, 18.82%), severe acute malnutrition (n = 69, 13.97%), and meningitis (n = 67, 13.56%). On average, the highest number of antimicrobials per card was observed in neonates. The percentage of antimicrobials administered by parenteral route was found to be 84.33%. Less than half of antimicrobials (46.98%) were prescribed with dosage form. Besides, strength and duration were recorded in 20.03% and 4.21% of antimicrobial agents, respectively. Conclusion: Generally, there was an overuse of injectables despite the fact that oral formulations are safer alternatives. This result is too far from World Health Organization (WHO) standard (13.4%-21.1%). The degree of polypharmacy of antimicrobials falls within the WHO cutoff point (<2). There are no antibiogram tests conducted in the hospital. By and large, this study provides an impetus towards the establishment of antimicrobial stewardship programs.
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