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Antibiotics are the most prescribed medication and the misprescribing of antibiotics is a public health problem worldwide.Objective: Conduct a meta-analysis to determine the prevalence of antibiotic prescribing, assess the quality of prescribing and identify factors of inappropriate prescribing in Morocco.Materials and Methods: 92 articles found in databases (35, 42, 55 and 50, in Elsevier, PubMed, Google Scholar and Other engines respectively).Results: In studies carried out in 2009 and 2011, on the evaluation of the use of antibiotics by dermatologists we noticed that beta-lactams were the most commonly prescribed: 53%. A survey on the use of generic antibiotics or pediatric service used beta-lactam, 63%. The prescription of antibiotics in the department of burns and plastic surgery was 65%. These results are important to explain a resistance of betalactamins to different offences and the constitution of beta-lactamase should be searched. A study conducted in 2018 in Rabat, 90 physicians and surgeon’s specialists, 91.7% of them prescribed antibiotics. Through previous studies from 2014 to 2022, a children’s under 5 years of age with severe clinical pneumonia, 86.5% received antibiotics. In another study on the evaluation of antibiotic prescriptions in the emergency department, amoxicillin was used in 31.4%. Also in a study on the evaluation of antibiotic prescriptions in pediatric emergency departments, 3rd generation cephalosporins were used in 69% of cases. A study of antibiotic self-medication parents knew that antibiotics are subject to a prescription and 72.1% knew that antibiotics had side effects on children, and in this study amoxicillin was used the most at 46.6%, and it is one of the most widely used antibiotics in Morocco, despite the development of numerous resistances. In studies conducted in 2009, 2016, and 2017 on preventive antibiotic use is still prescribed (22%, 17.7% and 7.14%). Antibiotic prescriptions were not limited only to physicians, but studies indicated that 10.9% of them were prescribed by pharmacists and in 2022 the percentage increased to 42%.Conclusion: This meta-analysis on studies and research of antibiotic prescribing: national data in the last 13 years in Morocco, the deficiencies found in antibiotic prescribing require the establishment of national recommendations to reduce misprescribing.

Background: Establishment of the intestinal flora in childhood is a critical window for growth and development. Objective:The aim of the current meta-analysis is to investigate the composition, development of intestinal flora in children and its change with certain pathologies. Material and methods: A comprehensive search was conducted in Scopus, PubMed, Google Scholar and Other engines. A total of 603 articles were identified of them only 11 fulfilled our inclusion criteria. Results: Composition of the intestinal flora in children: Firmicutes (51.1%) and Bacteroidetes (36%) at the phylum level. Bacteroidaceae, Lachnospiraceae (17.5%) and Ruminococcaceae (13.9%) at family level. Bacteroides, Prevotella, Faecalibacterium and Bifidobacterium (16%, 8.69%, 7.51%, and 5.47%, respectively) at genus level. Children with cystic fibrosis had different intestinal microbiota structures compared to healthy children. Alterations of the intestinal microbiota could be a predisposing factor for the multi-systemic inflammatory syndrome. In SARS CoV-2: Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Verrucomicrobia (51%, 25%, 12%, 9%, and 2%, respectively). In non-diabetic children: Enterococcus 28.4%, and in children with type 1 diabetes Enterococcus 22.8%. The diversity and stability of the microbial composition: Bacteroidetes, Proteobacteria, Firmicutes, Actinobacteria, Fusobacteria, and Verrucomicrobia are different in diabetic and non-diabetic children. The percentage of microbiota species in children with signs of constipation varies compared to children without constipation. In children and adults, there is variation in species composition at the family, phylum, and genus level. Bacteroidetes raised in the severe autistic group. Dysbiosis was elevated in autistic children compared to healthy children. Sutterella sequences were absent in healthy children. Conclusion: It is a very important to know the influence of the change in the microbiota predisposition to develop different pathologies or the opposite, which opens a wide range in this subject, hence the importance of carrying out more in-depth studies and research, especially in childhood.

Bacterial resistance to antibiotics has a very important role because it constitutes a threat to human health, especially immunocompromised people and children, this phenomenon can lead to difficulty or even the impossibility of treating certain infections. A meta-analysis from studies in Morocco on bacteria resistant to antibiotics over the last nine years and interest of bacterial: S. pneumoniae, N. meningitidis, H. influenzae and S. aureus, also the evolution their resistance. Total 654 articles in databases (206, 162, 134, and 152 articles found in: Elsevier, PubMed, Google Scholar, and other engines, respectively). For the bacteria in which we were interested, the prevalence of resistance increases with the years. Indeed, S. pneumoniae, N. meningitidis and H. influenzae, prevalence in 2012, 2016 and 2018 was respectively around (13%, 9.7%, 5.4%), (48%, 24%, 8%) and (29%, 33%, 8%). The evolution of the resistance of S. pneumoniae, was impacted by the introduction of the vaccine, indeed, the rate of its resistance to the antibiotic erythromycin before vaccination was 76% but after the introduction of the vaccine it decreased to 61%, while the incidence of pneumonia was 17.7%, and after vaccination it decreased to 10.2%. Also, the resistance of S. pneumoniae to penicillin G increased from 2.7% in 2011 to 100% in 2020. For N. meningitidis, resistance to penicillin G increased from 11.1% to 24% between 2012 and 2019. About of H. Influenzae for Bactrim, fluoroquinolones and tetracycline (16%, 4.8%, 2.5%), S.aureus resistance increases significantly. From 2016 to 2018, the resistance of S. aureus (Penicillin G 92%, ciprofloxacin 16.5%, erythromycin 14.6%).