Pattern of antibiotic use in a tertiary hospital in Nigeria

Abstract

Background Antibiotics are among the most commonly prescribed drugs in paediatrics. Due to an overall rise in healthcare costs, lack of uniformity in drug prescribing despite standard treatment guidelines and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies are warranted. Purpose To access the prescribing pattern of antibiotic use in the treatment of prevalent paediatric diseases at Federal Medical Centre Owerri, to compare this pattern to the standard treatment guidelines and to estimate the cost implications of this pattern on the hospital drug budget. Materials and methods A retrospective study covering January 2002 to December 2006 was done. Medical records of paediatric inpatients of age 0-12 years were reviewed. Total number of cases was 5968. Results The average number of medicines per patient ranged from 5.17 in 2002 to 7.9 in 2006 and percentage of antibiotics per prescription also ranged from 63.3 in 2002 to 86.6 in 2006 The most common disease in this hospital was malaria followed by bronchopneumonia. Out of the 5968 children clinically diagnosed with these diseases and treated with antibiotics, specimens were taken for culture in only 1648 cases (33%) to identify pathogenic organisms. Children 1-5 years received antibiotics more frequently than all the other groups. 80-86% of total antibiotics were administered parenterally and 80-85.5% of drugs were prescribed from the hospital formulary. Cephalosporins were the most frequently prescribed antibiotic followed by penicillin and then aminoglycosides. 21-26% of the hospital budget was spent on antibiotics. High-cost broad-spectrum antibiotics were commonly used. Conclusions This study revealed significant flaws in the prescribing pattern of antibiotics in the paediatric department of this hospital. It is pertinent to note that because children are at greater risk of receiving multiple courses of antibiotics and in view of the risk of antibiotic resistance, strategies to control antibiotic resistance should focus on this patient population.

Prescribing pattern and antibiotic use for hospitalized children in a Northern Nigerian Teaching Hospital

“…[ 27 ] Although the WHO standard value was obtained largely from adult outpatient settings across developing countries (with fewer pediatric prescriptions),[ 27 ] they remain the only valid reference standards available for such comparison. Compared to what was reported in similar studies in Ethiopia, Sierra Leone, Nigeria, and India,[ 5 6 17 18 19 30 31 32 ] the average of 2.1 drugs per encounter in this study is the lowest even though just slightly above the WHO standard. The difference between the finding in this study and these cited reports could, however, be attributed to differences in study methodology.…”

“…[ 17 ] Cole et al ., in Sierra Leone, reported 82.99% of prescriptions containing antibiotics, being also the second most commonly prescribed medicines. [ 18 ] In Nigeria, Anyanwu and Arigbe-Osula[ 19 ] found between 63.3% and 86.6% of prescriptions containing antibiotics, whereas the rate of antibiotic prescribing was higher for children aged 1–5 years compared to other groups combined. They also found that 80%–86% of antibiotics were parenteral and 80%–85.5% were prescribed from the hospital formulary with the most common being cephalosporins, penicillin, and aminoglycosides.…”

“…They also found that 80%–86% of antibiotics were parenteral and 80%–85.5% were prescribed from the hospital formulary with the most common being cephalosporins, penicillin, and aminoglycosides. [ 19 ]…”

Empirical Antibiotic Prescription Pattern among Patients in a Nigerian Tertiary Hospital, is There Evidence of Irrationality?

“…Antibiotic prescription practices vary widely between countries and healthcare facilities; factors which have been reported to influence antibiotic use includes infectious disease burden, prescription habit of clinicians, microbial resistance pattern, regulatory control, standard treatment guidelines, availability and economic factors [23][24][25][26][27][28][29][30][31]. In resource scarce setting where routine empirical antibiotic use is widespread, prescription pattern also vary widely [22].…”

“…In many healthcare facilities where laboratory services are available, antibiotic prescriptions are not routinely based on microbial sensitivity results a common cause of irrational use [26,41,44]. Many antibiotic prescription studies have reported both high levels of irrational use and an increasing level of resistance to commonly used antibiotics [23,45].…”