Antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a paediatric hospital in Nigeria

Abstract

Background: The burden of infectious diseases among Nigerian children is high. These children are often prescribed antibiotics during periods of hospitalisation. Unfortunately antibiotic resistance (ABR) threatens the availability and efficacy of antibiotics for use by vulnerable children and the future generations. Monitoring prescribing trends in our hospital as a means of identifying targets for improving prescribing is inevitable.
Objective: The aim of the study was to evaluate antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a Paediatric hospital in Nigeria.
Methods: A retrospective survey was carried out using case notes of previously hospitalised patients admitted between January and June 2016. Data from 150 case notes of patients admitted for suspected bacterial infections were collected using a predesigned data collection form. Patients’ demographics, infection type, details of prescribed antibiotics, length of hospital stay and microbiological assessments were noted. Data were analysed using statistical package for social sciences (SPSS) version 22. Frequencies and percentages were calculated for categorical variables. Means and standard deviations were calculated for continuous (numerical) variables. Correlation was also employed in the analysis.
Results: Of the 150 patients, 53.3% were males and 86% were children under 5 years of age. The mean duration of hospital stay was 7.59 (± 5.4) days. The most common infections were respiratory tract infection (32%) and sepsis (31.3%). The most common empirically prescribed antibiotics at the onset of admission were Gentamicin and a fixed dose combination of Ampicillin/Cloxacillin which were prescribed for 64.7% and 52.7% of the patients respectively. Cultures were ordered for only 7 (4.7%) of patients at the onset of hospitalisation. All antibiotics administered on admission were parenteral formulations and only 4% of the patients had their antibiotic switched to oral route on or before the third day of patients’ admission. Another 71.3% were converted to oral formulations on the day of discharge from the hospital. A total of 87.3% were discharged on antibiotics and the most commonly prescribed antibiotic at discharge was Cefixime (37.2% of antibiotics prescribed as take home medication).
Conclusions: Antibiotics were started empirically in all cases and cultures were ordered for few patients at the start of antibiotic therapy. Cultures should be more frequently ordered in the hospital to guide antibiotic prescribing for patients admitted for suspected bacterial infections. In addition, timely intravenous (IV) to oral (PO) antibiotic switch should be practised whenever appropriate. Educating physicians on the benefits of early switch from IV to PO formulations when appropriate is also recommended. Initiatives such as the “Antibiotic Time out” or Start Smart-then Focus approach will be appropriate in the hospital. Introduction of an empiric antibiotic policy in the hospital is highly recommended.