Burden and Risk Factors of Antimicrobial Use in Children Less Than 5 Years of Age with Diarrheal Illness in Rural Bangladesh

Abstract

Antimicrobial overuse contributes to antimicrobial resistance. Empiric use of antimicrobials for diarrheal illness is warranted only in a minority of cases, because of its self-limiting nature and multifactorial etiology. This study aims to describe the factors contributing to antimicrobial overuse for diarrheal disease among children less than 5 years of age in rural Bangladesh. A total of 3,570 children less than 5 years of age presenting with diarrhea in a tertiary level hospital were enrolled in the study. The rate of antimicrobial use at home was 1,395 (39%), compared with 2,084 (89%) during a hospital visit. In a multivariate analysis, factors associated with antimicrobial use at home included residence located more than 5 miles from a hospital; use of zinc and oral rehydration salts at home; vomiting; greater than 10 stools per 24 hours; diarrheal duration greater than 3 days; and rotavirus diarrhea ( < 0.05 for all). Characteristics of children more likely to be given antimicrobials in a health-care setting included greater than 10 stools per 24 hours; duration of diarrhea greater than 3 days; use of antimicrobials before hospital presentation; fever (≥ 37.8°C); rectal straining; and infection ( < 0.05 for all). The most commonly used drugs in rotavirus diarrhea were azithromycin and erythromycin, both before hospital presentation and during hospital admission. Our study underscores the importance of diligent vigilance on the rationale use of antimicrobials both at home and in health-care facilities with a special concern for children less than 5 years of age living in rural Bangladesh.

Clinical and socio-environmental determinants of multidrug-resistant vibrio cholerae 01 in older children and adults in Bangladesh

“…This finding is consistent with multiple other studies and known mechanisms of acquired resistance, demonstrating that patient antibiotic use places selective pressure towards MDR (Das et al, 2013). Antibiotic use was common, with nearly one-third of subjects reporting antibiotic use prior to hospital presentation, consistent with a study that found 39% home (non-prescription) antibiotic use among young children in rural Bangladesh (Mirzapur) (Ahmed et al, 2018).…”

Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors

“…Health sector (combined by 'OR') (b) Geographic location (combined by 'OR') (c) and/or its indiscriminate use [17]. Studies reveal two or more antimicrobials to be commonly prescribed at a time in Bangladesh [14,15,18,19,20,22,30,31], and more antimicrobials to be prescribed in hospital settings compared to community settings [21]. Prescribing antibiotics without laboratory tests was quite common in Bangladesh due to reported lack of testing facilities [18,19,22].…”

Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill

“…Drug shops fill an important gap in healthcare infrastructure in Bangladesh and are reported to be the preferred first point of contact for most of the population because of the low cost, long opening hours and wide geographic spread [15, 17]. In a recent study, Ahmed et al [18] found that among children presenting at a tertiary hospital with diarrhoea, of those who had already taken antibiotics at home only 6% had been prescribed by a qualified provider. One study observing practice in 75 drug shops found that antibiotics were the highest selling medicine [13].…”