Empiric antibiotic prescription among febrile under-five Children in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Abstract

Background: More than 97% of febrile infants and young children have self-limiting viral infection and therefore, would not require antibiotics. Over prescription of antibiotics increases antibiotics exposure and development of resistance among patients. There is need to evaluate empiric antibiotic prescription in order to limit its use to only febrile children with bacterial infection. Aim and Objectives: The aim of this study was to determine the prevalence of empiric antibiotic prescription among febrile underfive, post neonatal children presenting in the children outpatient clinic of the University of Port Harcourt teaching hospital. Method: Febrile Children aged 29 days to <60 months who presented in the outpatient clinic were recruited from September 2010 to January 2011. Their weight, biodata, symptoms, Physician's diagnosis, and names of antibiotic prescribed were entered into a predetermined proforma and analysed. Result: A total of 362 children with male to female ratio of 1.03:1 were studied. Two hundred and eighty three (78.2%) febrile children received empiric antibiotic prescriptions. The most frequent antibiotic prescribed was amoxicillin 80 (28.3%). Children aged 1-12months received the highest number of prescriptions 113 (80.7%). There was no significant relationship between age, temperature level, weight for age, number of symptoms and frequency of antibiotic prescription (p>0.05). Upper respiratory tract infection (83.7 %) and diarrhea (55.9%) were significantly associated with empiric antibiotic prescription (P=0.05 and 0.002 respectively). Conclusion: Empiric antibiotic prescription for febrile under-five children is a common practice in UPTH. Physicians should therefore reduce the frequency of antibiotics prescription in febrile children unless there is clinical evidence of bacterial infection.

Pre-hospital exposures to antibiotics among children presenting with fever in northern Uganda: a facility-based cross-sectional study

“…In fact, 96.4% of the children who received antibiotics during their febrile illnesses in this study also had a cough. This finding correlates with reports from Nigeria [ 14 ], Uganda [ 25 ] and Vietnam [ 26 ] where upper respiratory tract infections (common cold) were a cause of up to 83.7, 70.5 and 63% antibiotics exposure among children respectively, and corroborates that reported among adult patients in the Kingdom of Saudi Arabia [ 35 ]. Similarly, in surveys conducted in rural China [ 31 ] and Indonesia [ 37 ], antibiotics were 42% more likely to be used if the child had a cough and/or common cold.…”

“…The study population comprised children aged 6-59 months with fever presenting to the tertiary health facility during the study period. A sample size of 210 participants was estimated using the single population proportion formula based on a proportion of antibiotic exposure (P) of 83.7% [ 14 ], with a marginal error (D) of 5%, a standard normal value (Z) corresponding to 95% certainty (1.96).…”

“…In these settings, the majority of caregivers initiate treatment of their children at home before presentation to a health facility [ 10 – 12 ] and is a common cause of self-medication with antibiotics. Caregivers assume the crucial role of undertaking the primary diagnosis, assessing the severity and making the decisions to seek or not to seek healthcare and initiate treatment, including use of antibiotics [ 13 ], notwithstanding that over 97% of febrile infants and young children have a self-limiting viral infection and therefore do not require antibiotics [ 14 ]. Help is only sought thereafter when the fever is unremitting or if complications set in [ 12 , 15 , 16 ].…”

Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria

“…From the present study, nearly all the antibiotics prescribed (98.9%) were based on signs and symptoms indicative of bacterial infections, and > 98% were broad-spectrum agents for all possible pathogens associated with the site of infection. This largely indicates that most of the antibiotics prescribed for the under-five children were empirically prescribed, thereby further corroborating the widespread empirical nature of antibiotic prescribing in many developed and developing countries36,46–49.…”

Antibiotics Resistance, Sensitivity Pattern and Development of Antibiogram to Support Empirical Prescription in Health Facilities in South Senatorial District of Kwara State, Nigeria

“…The situation report presented by Nigeria Centre for Disease Control revealed a trend of the wide spread of resistance strain to watch a group of antibiotics according to World Health Organization categorization [7]. In a study in Port Harcourt, Rivers State, Nigeria, it was observed that the Upper respiratory tract infection (83.7 %) and diarrhoea (55.9%) were significantly associated with empirical antibiotic prescription (P=0.05 and 0.002 [8]. Empirical prescription contributes greatly to antibiotic resistance.…”