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Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India
Ruxmaniben Deepchand Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India.;Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India..
Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, e0142317Article in journal (Refereed) Published
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Abstract [en]

Introduction Infectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India. Methods Data from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008-2011) using a customized form. Data from inpatients aged 0-18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant. Results Oftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95% confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral-and enteric fever were frequently prescribed antibiotics at both hospitals, yet higher proportion were prescribed antibiotics at the NTH compared to the TH. Broad-spectrum antibiotics were the most commonly prescribed antibiotic class in both hospitals, namely third generation cephalosporins, J01DD (69%) at the TH, and new fixed dose combinations of antibiotics J01R (FDCs, 42%) at the NTH. At the TH, 37% of the antibiotic prescriptions were comprised of antibiotics listed in the IAP-LEM, compared to 24% at the NTH (p<0.05). Conclusions Broad-spectrum antibiotics were prescribed frequently in both hospitals also for the un-indicated conditions such as viral fever and enteric fever. At the NTH, new FDCs were more frequently prescribed and adherence to the IAP-LEM was substantially lower at the NTH compared to the TH. The results demonstrate need to develop diagnosis-specific prescribing guidelines to facilitate rational use of antibiotics and implement antibiotic stewardship program.

Place, publisher, year, edition, pages
2015. Vol. 10, no 11, e0142317
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Pediatrics Infectious Medicine
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URN: urn:nbn:se:uu:diva-268788DOI: 10.1371/journal.pone.0142317ISI: 000364303800082PubMedID: 26540104OAI: oai:DiVA.org:uu-268788DiVA: diva2:881125
Funder
Swedish Research Council, K2007-70X-20514-01-3
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2017-12-01Bibliographically approved

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