Prescribing practices for pediatric out-patients: A case study of two teaching hospitals in Nigeria

Nduka, Sunday Odunke; Edebeatu, Chika; Isidienu, C. P.; Amorha, Kosisochi Chinwendu

doi:10.4314/tjpr.v16i3.28

Cited by 13 publications

(20 citation statements)

References 16 publications

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“…[ 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.…”

Section: Discussioncontrasting

confidence: 86%

“…The difference between the finding in this study and these cited reports could, however, be attributed to differences in study methodology. The use of inpatient treatment chart reviews in some of these studies,[ 17 18 19 30 31 32 ] perhaps did allow for obtaining the total number of drugs used per patient over the period of their admission, which will tend to give higher average number of drugs than what was obtained with only prescription orders in this study. Polypharmacy could potentially predispose to higher risk of drug–drug interactions and other adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies from tertiary hospitals in Nigeria reported on prescriptions for adult outpatients, leaving a gap of information for pediatric inpatients. A literature search using PubMed, MEDLINE, HINARI, Google Scholar, and Africa Journals Online, with appropriate search terms revealed only a few studies on outpatients that assessed prescribing using the WHO indicators[ 30 31 32 ] Although developed for use in outpatient settings in primary level facilities, the indicators have also been applied for inpatient settings of tertiary hospitals. [ 5 6 17 18 30 31 32 ]…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background:Assessment of patterns of drug to detect performance problems and compliance with standards facilitates objective comparisons and impact evaluation. Children are at higher risk of consequences of irrational prescribing and antibiotic misuse.Objective:The objective of the study was to evaluate the prescribing pattern and utilization of antibiotics for children using standard prescribing indicators and indices of rational drug prescribing.Materials and Methods:This was a retrospective study of prescriptions for pediatric inpatients at a teaching hospital in Northern Nigeria. Information was obtained from eligible prescriptions received over 24-month period using a modified WHO prescribing indicator form. The WHO prescribing indicators and the Index of Rational Drug Prescribing (IRDP) were used to evaluate prescriptions. Data were analyzed and presented as proportions, means, tables, and charts, comparing with WHO standards and with findings of similar studies.Results:There were 3908 eligible prescription orders, with a mean patient age of 3.1 (±2.7) years. With an average of 2.1 drugs per prescription, 66.8% were written with generic names, whereas a single antibiotic was included among 63% of prescriptions with antibiotics. Antibiotics and injections were contained in 49.5% and 67.7% of prescriptions, respectively. Medications were available in the Essential Medicines List in 95.5% of cases. The IRDP obtained is 2.99, against a standard of 5. Aminoglycosides, cephalosporins, and penicillins were the most common choices, whereas ampicillin/cloxacillin was the most common combination.Conclusion:Drug prescribing and antibiotic use were generally inappropriate compared with ideal standards. Continuous training/retraining on rational drug use, periodic monitoring, and use of treatment protocols in tertiary hospitals are recommended.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Other characteristics of studies that reported a mean number of medications without reporting prevalence included evaluating multiple drugs/classes and being in international settings (Table S3). Table S3 also shows the rest of the studies that reported prevalence or average number of medications.…”

Section: Resultsmentioning

confidence: 99%

Variation of the prevalence of pediatric polypharmacy: A scoping review

Baker

Feinstein

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. Methods We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. Results Two hundred eighty‐four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross‐sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%‐54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%‐61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%‐50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. Conclusions The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.

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“…Therefore, the objectives of this study were to evaluate the demographic characteristics of patients in the adult out-patient pharmacy of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, describe the antibiotics use pattern, determine the antibiotics prescriptions per encounter, determine if prescribed antibiotics are on essential drug list and determined the cost associated with antibiotics use in the study site. Previous studies in NAUTH [11,12], evaluated drug use in children in out-patient pharmacy and geriatric in-patients respectively. Additional knowledge on antimicrobials use in adult out-patient pharmacy will augment the understanding of antibiotic use in a typical Nigerian tertiary health institution and help develop standards for guidelines for antibiotic use process in teaching hospitals in Africa generally and Nigeria in particular.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of One-Year Antibiotics Utilization in the Adult Outpatient Pharmacy of a Nigerian Tertiary Health Institution

Oli

Onyeaso

Emencheta

et al. 2020

Preprint

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Abstract Background: Antibiotics are among the most common drugs used worldwide.They kill or prevent the growth of bacterial microorganisms in the body, hence, they are the major agents used in treating bacterial infections. Because they are prone to abuse and misuse, regular evaluation of their utilization is important for optimal healthcare delivery.Objective: This study determined the antibiotics type, utilization, prescriptions and cost patterns in the adult out-patient pharmacy of a public tertiary health facility in Nigeria.Methods: This is a retrospective observational study using medication utilization records (prescriptions) to investigate the study objectives. Prescriptions dispensed in 2018 in adult out-patient pharmacy of Nnamdi Azikiwe University Teaching Hospital, Nnewi were reviewed. Data were evaluated using the World Health Organization-developed prescribing indicators. Descriptive and inferential statistics were used to analyze the results. The percentage and averages of the variable were calculated.Results: The medication utilization records showed that there was a significantly higher proportion (P-value = 0.0038) of females (70%) compared to males (the ratio being 2.44:1.00) that were prescribed antibiotics. The antibiotic utilization profile showed that antibiotic selection by class was significantly different and accounted for 44.02% of the total variance seen in the prescription pattern (P-value is < 0.0001). Also, the age of participants accounted for 19.48% of the total variance seen in the selection practice and so, age significantly affected the selection practice/prescription pattern with P-value < 0.0001. Dosage forms profile showed that the oral dosage forms were significantly more prescribed (P-value < 0.0001) compared with any other dosage form encountered in the study. There was no significant difference in the prescription patterns of parenteral and other dosage forms (P-value > 0.05). A greater percentage (84.22 %) of the prescriptions was from the Essential Drug list of Nigeria. Conclusion: Though the percentage of antibiotics prescribed from essential medicines list was found to be satisfactory, a strict protocol for prescribers is required to promote rational antibiotics use. This would not only prevent antibiotic resistance but also reduce the treatment expenditure and encourage antibiotic stewardship.

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Prescribing practices for pediatric out-patients: A case study of two teaching hospitals in Nigeria

Cited by 13 publications

References 16 publications

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

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

Variation of the prevalence of pediatric polypharmacy: A scoping review

Evaluation of One-Year Antibiotics Utilization in the Adult Outpatient Pharmacy of a Nigerian Tertiary Health Institution

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