Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR

Abstract

Background The irrational use of antibiotics has been identified as a major problem in healthcare, and it can lead to antimicrobial resistance, treatment failure, and increased healthcare costs. Although many studies worldwide have focused on the irrational use of drugs, reports on prescription practice in Lao PDR remained limited. This study aimed to examine the patterns of antibiotic prescription for under-fives with common cold or upper respiratory tract infection (URTI) at pediatric outpatient divisions. Methods One provincial hospital (PH) at Kaisone Phomvihane and four district hospitals (DHs) at Songkhone, Champhone, Atsaphangthong, and Xepon in Savannakhet Province were selected. Healthcare providers at these hospitals were interviewed and medical records of under-fives from 2016 were examined. Results Of the 54 healthcare providers interviewed, 85.2% had seen the standard treatment guideline, 77.8% adhered to this guideline, and 90.7% knew about antimicrobial resistance, while 18.5% participated in antimicrobial resistance activities. Medical records of 576 outpatients (311 boys and 265 girls) with common cold or URTI were examined, 154 at the PH and 422 at the DHs. Although antibiotics prescription proportions were similar between facilities at both levels (68.8% and 70.9% at the PH and DHs, respectively), antibiotics were exclusively prescribed for URTIs (96.4%), not for common cold (4.9%). First-line antibiotics recommended by WHO Model List of Essential Medicines for Children the 6th List were prescribed for 81.5% of patients; mainly, beta-lactam antibiotics were prescribed (87.2% of prescribed antibiotics). There were no cases in which two or more antibiotics were prescribed. The correct dose according to the National STG was 31.9% as a whole. The difference in the correct dose between the PH (52.8%) and the DHs (24.4%) was significant ( p < 0.001). Conclusions This study demonstrated the patterns of antibiotic prescription for under-fives with common cold or URTI among healthcare providers from two different levels of facilities. Although an appropriate number of generic first-line antibiotics in the essential drug list were prescribed, the dosage and duration of antibiotic use were not appropriate. In order to further improve antibiotic prescription practices, regulation by the government is necessary; this could also decrease antimicrobial resistance and improve treatment outcomes.

Knowledge, Attitudes, Perception and Reported Practices of Healthcare Providers on Antibiotic Use and Resistance in Pregnancy, Childbirth and Children under Two in Lao PDR: A Mixed Methods Study

“…The rational use of medicines occurs when a correctly selected medicine is prescribed for appropriate indications, in doses that meet their own individual requirements, for an adequate period of time, at the lowest cost for both the patients and the society [ 4 ]. Several studies have shown that inappropriate antibiotic use is widespread across the globe [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Use of antibiotics for common illnesses among children aged under 5 years in a rural community in Indonesia: a cross-sectional study

“…Numerous children with ARI and diarrhea are treated with antibiotics. However, in these cases, antibiotic treatment may not be required [6–8]. Previous studies have shown that the use of antibiotic was associated with higher rates of resistance in children [9, 10].…”

Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy

“…Antimicrobials were prescribed for between 45% and 70% of inpatients in Lao hospitals from 2004 to 2018. [57][58][59][60] Doctors stated that they mainly prescribed antibiotics according to the National Standard Treatment Guidelines (STG), advice from their peers or from more experienced colleagues. 57 Until recently these guidelines have not included detailed recommendations for antimicrobial prescribing for the diversity of Lao infectious diseases, but detailed MoH antimicrobial guidelines have now been released.…”

“…First-line antibiotics based on Lao National STG (amoxicillin, ampicillin, erythromycin and penicillin V) were the most commonly prescribed. 60 A large survey in Salavan Province between 2017 and 2018 revealed that among 796 participants from communities, 39% claimed that they used antibiotics during their previous illness and 22% admitted that they used antibiotics without indications or from informal sources. 63 'Ampi' or ampicillin was the most commonly mentioned antibiotic, by 76% of 775 survey participants, and wound treatment (44%) was the main reason for antibiotic use in Salavan in the same period.…”