Qualitative evaluation of antibiotic usage in pediatric patients
Abstract
Background Antibiotics are among the most commonly prescribed drug for pediatric patients. Inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistence. Antibiotic uses can be evaluated quantitatively and qualitatively.
Objective To qualitatively evaluate antibiotic use in patients using Gyssens algorithm.
Methods We performed a descriptive, retrospective study of matient medical records of those admitted to the pediatric ward from January 1 – June 30, 2009. Records were screened for patient antibiotic use, followed by qualitative evaluation using Gyssens algorithm on data from patient who received antibiotic treatment.
Results We found 49.2% of subject were prescribed antibiotics. The majority of patients given antibiotics were aged 1 month - 1 year (39.3%). Antibiotic use was categorized by therapy type : empirical, prophylactic, or definitive. We found empirical therapy in 73% of cases, prophylactic in 8%, and definitive in 15%. Cefotaxime was the most common antibiotic used (25.1%), followed by ceftazidime (14%) and cotrimoxazole (1%). 39.6% of subjects were given antibiotics appropriately, while 48.3% were given inappropriately. In 3.3% of patients, antibiotics were given without indication and in 8.8% there was insufficient data.
Conclusions Of hospitalized patients receiving antibiotic treatment at the Departement of Child Health, Cipto Mangunkusumo Hospital, 39.6% were given antibiotic appropriately, while 48.3% were given antibiotics inappropriately. Cefotaxime was the most commonly used, as well as most inappropriately given antibiotic.
References
2. Ceyhan M, Yildirim I, Ecevit C, Aydogan A, Ornek A, Salman Na et al. Inappropriate antimicrobial use in Turkish pediatric a multicenter point prevalence survey. Int J Infect Dis. 2010;14:55-61
3. Sorensen TL, Monnet D, Control of antibiotic use in the community: the Dannish experience. Infect Control Hosp Epidemiol. 2000;21:387-9
4. Radyowijati A, Haak H, Improving antibiotic use in low- income countries: an overview of evidence on determinants. Soc Sci Med. 2003;57:733-44.
5. The AMRMRIN study group. Antimicrobial resistance, antibiotic usage and infection control; a self-assessement program for Indonesian hospitals. Jakarta: Direktorat Jendral Pelayanan Medis; 2005. p.17-25.
6. Loho T, Astrawinata DAW. Peta bakteri dan kepekaan terhadap antibiotic RSUPN Cipto Mangunkusumo, Januari-Juni 2009. Jakarta: Departemen Patologi Klinik CMH/FKUI; 2009. p.4-12.
7. Gyssens IC, Van den Broek PJ, Kullberg BJ, Hekster Y, Van der Meer JWM. Optimizing antimicrobial therapy. A method for microbial drug use evaluation. J Antimicrob Chemother. 1992;30:724-7
8. Trihono PP, Alatas H, Tambunan T, Pardede SO. Konsensus tatalaksana sindrom nefrotik pada anak. Edisi kedua. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2008.p.17-20.
9. Husni A. Profil antibiotic pada anak diruang rawat anak Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia/RSUP Cipto Mangunkusumo [thesis]. [Jakarta]: University of Indonesia.2003. p.18-26.
10. Gyssens IC, Gerlig IEJ, Dony JMJ, Van de Vliet JA, Van der Kampen A, Van den Broek PJ, et al. Optimizing antimicrobial drug use in surgery: an intervention study in a Dutch University Hospital. J Antimicrob Chemother. 1996;38:1001-12.
11. Potocki M, Goette J, Szucs TD, Nadal D. Prospective surgery of antibiotic utilization in pediatric hospitalized patients to identify targets for improvement of prescription. Infection. 2003;31:398-403.
12. Shankar PR, Upadhyay DK, Subish P, Dubey AK, Mishra P. Prescribing patterns among pediatric inpatients in a teaching hospital in Western Nepal. Sin Med J. 2006;47:261-5.
13. Gyssens IC. Audits for monitoring the quality of antimicrobial prescription. In: Van der Meer JW, Gould IM, editors., Antibiotic policies theory and practice. New York: Kluwer Academic; 2005. p. 197-226.
14. Soedarmo SSS, Garna H, Hadinegoro SRS, Satari HI, Pemakaian antimikroba dibidang pediatric. Soedarmo SSS, Garna H, Hadinegoro SRS, Satari HI. Buku Ajar Infeksi & Pediatri Tropis. Jakarta: Badan Penerbit IDAI; 2008. p.66-82.
15. Aswapokee N, Vaithayapichet S, Heller RF. Pattern of antibiotic use in medical wards of a university hospital, Bangkok Thailand. Ref Infect Dis. 1990;12:136-41.
16. Ayuthya SK, Matangkasombut OP, Sirinavin SM, Malathum K, Sathapatayavongs B. Utilization of restricted antibiotics in a university hospital in Thailand. Southeast Asian J Trop Med Public Health. 2003;34:179-86.
17. Tambunan T. Keputusan klinik dalam penggunaan antibiotic. Sari Pediatri. 2004;6:52-6.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2016-10-10
Published 2011-12-31