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Published on: August 30, 2018
Evaluation of antibiotics in pediatrics using the defined daily doses method and the World Health Organization (WHO)
Heni Lutfiyati1,2, Jarir At Thobari3,4, Nanang Munif Yasin5
1Faculty of Pharmacy, Doctoral Program in Pharmaceutical Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Insights
Irrational antibiotic use in Indonesian children is high, with over half of prescriptions falling into the "Watch" category. This study highlights the need for better antibiotic stewardship in pediatric care to combat resistance.
Area of Science:
- Pharmacology
- Public Health
- Pediatrics
Background:
- Irrational antibiotic use contributes to antibiotic resistance, increasing morbidity, mortality, and healthcare costs.
- Children are a vulnerable population frequently prescribed antibiotics, making them a focus for antibiotic stewardship.
- Antibiotic resistance is a growing global health concern, necessitating careful monitoring of antibiotic consumption patterns.
Purpose of the Study:
- To evaluate antibiotic utilization patterns in pediatric patients in Indonesia.
- To quantify antibiotic use using the Defined Daily Doses (DDD) method.
- To classify antibiotic use according to the World Health Organization's (WHO) Access, Watch, and Reserve (AWaRe 2021) classification.
Main Methods:
- An observational, quantitative, cross-sectional study was conducted in two referral hospitals in Central Java, Indonesia, from January to December 2020.
- Antibiotic use was measured using the Defined Daily Doses (DDD) per 100 patient days.
- Prescribed antibiotics were categorized using the WHO AWaRe 2021 classification system (Access, Watch, Reserve).
Main Results:
- A total of 505 pediatric encounters were analyzed.
- The most frequently prescribed antibiotics were cefotaxime (42.72%), ceftriaxone (22.91%), and ampicillin (12.11%), with cephalosporins being the most common class (69.89%).
- Total antibiotic consumption was 11.08 DDD/100 patient days, with cefotaxime being the highest (47.72%).
- Antibiotic use was predominantly in the 'Watch' category (68.4%), compared to the 'Access' category (31.6%).
Conclusions:
- Antibiotic consumption in the studied pediatric population in Indonesia was high.
- A significant proportion of antibiotic use, over half, fell into the 'Watch' category, indicating potential for antimicrobial resistance.
- Ceftazidime, cefixime, cefotaxime, and ceftriaxone were the most consumed antibiotics, highlighting specific agents for stewardship interventions.
Introduction:
irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021).
Methods:
this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s "AWaRe" categorization: "Access," "Watch," and "Reserve."
Results:
a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively.
Conclusion:
antibiotic use was high in the research setting. Over half of the antibiotic use was in the "Watch" group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.
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