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PRINT ISSN : 2319-7692
Online ISSN : 2319-7706 Issues : 12 per year Publisher : Excellent Publishers Email : editorijcmas@gmail.com / submit@ijcmas.com Editor-in-chief: Dr.M.Prakash Index Copernicus ICV 2018: 95.39 NAAS RATING 2020: 5.38 |
Background: Diarrheal disease is the second leading cause of death in children under five years. It’s responsible for around 525, 000 deaths of children every year. The use of antibiotics for treatment of pediatric diarrhea has been observed in spite of World Health Organization guidelines which discourage the use of antibiotics for treating acute diarrhea. Here we assess the extent of irrational use of antibiotics in management of acute watery diarrhea among under-five children both at home and health setting. Methods: Children under 5 years of age (n = 147) presenting at Mohammed Al-Amin Hammed Hospital with acute watery diarrhea were included in the study. Background information on the children was collected by questionnaire, including home treatments, and clinical information including symptoms and treatment were provided at hospital. Data were collected and analyzed for associations between variables and use of antibiotics using Chi-square statistic (X2). Results: Among the 147 patients, 87 (59.3%) were males and 60 (40.7%) were females. The mean age of the children was 12 ± 12.1 months. 119(80.9%) were treated as in patient, while 28(19.1%) were treated as outpatient. 61(53%) were admitted because of ongoing losses, (24.3%) admitted because they were malnourished children, 25(21.7%) had some dehydration. (63.7%) didn’t have stool analysis done and only 36.3% had stool analysis done. 110 (76%) received antibiotics, which prescribed by health care provider. Regarding antibiotics, 82(63.4%) were third generation cephalosporin in form of Ceftriaxone, cefotaxime and cefixime, followed by benzyl penicillin and gentamycin injection for 72 (55%), and 24 (18.6%) metronidazole. Use of antibiotics was not influenced by age of the child, reason of admission or stool analysis. The only variable positively associated with antibiotic prescription was diarrhea from one to three days at admission. Conclusion: It is clear that young children presenting with acute watery diarrhea to Mohammed Al-Amin Hammed Hospital are likely to be treated with antibiotics, despite there is being no obvious reason that this treatment is appropriate. Our study results support the need for institution-based antimicrobial stewardship to be implemented to decrease antimicrobial resistance.
Centers for Disease Control and Prevention. Antibiotic use in the United States, 2017: progress and opportunities. Atlanta, GA: US Department of Health and Human Services, CDC. 2017 Nov.
Efunshile, A. M., Ezeanosike, O., Nwangwu, C. C. et al., Apparent overuse of antibiotics in the management of watery diarrhoea in children in Abakaliki, Nigeria. BMC Infect Dis 19, 275 (2019). https://doi.org/10.1186/s12879-019-3899-1.
Ekwochi U, Chinawa J M, Obi I, Obu H A, Agwu S. Use and/or misuse of antibiotics in management of diarrhea among children in Enugu, Southeast Nigeria. J Trop Pediatr. 2013 Aug;59(4):314-6. https://doi.org/10.1093/tropej/fmt016. Epub 2013 Apr 24. PMID: 23619599.
Fleming-Dutra KE, Hersh A L, Shapiro D J, Bartoces M, Enns E A, File T M Jr, Finkelstein JA, Gerber J S, Hyun D Y, Linder J A, Lynfield R, Margolis D J, May L S, Merenstein D, Metlay JP, Newland J G, Piccirillo JF, Roberts RM, Sanchez GV, Suda K J, Thomas A, Woo T M, Zetts R M, Hicks L A. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016 May 3;315(17):1864-73. https://doi.org/10.1001/jama.2016.4151.
Gashaw, A. Assessment of the Management of Diarrhea in Children under Five in Health Centers of Addis Ababa City Administration, Ethiopia. Doctoral Dissertation, Addis Ababa University, Addis Ababa (2015).
Gwimile, J. J., Shekalaghe, S. A., Kapanda, G. N. and Kisanga, E. R. Antibiotic Prescribing Practice in Management of Cough and/or Diarrhoea in MoshiMunicipality, Northern Tanzania: Cross-Sectional Descriptive Study. Pan African Medical Journal, (2012), 12, 103. https://doi.org/10.11604/pamj.2012.12.103.1716
https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease
Huluka U A, Dessiso A H. Assessment of Diarrheal Disease Management Practice in Under-Five-Year Children According to WHO Guideline in Health Facilities of Hawassa City, SNNPR, Ethiopia. Health. 2020 Oct 13;12(10):1345-59
Kmietowicz Z. One in five GP prescriptions for antibiotics is inappropriate. BMJ. 2018 Feb 27;360:k936. https://doi.org/10.1136/bmj.k936. PMID: 29487052.
Lafta, R. K., Al-shatari, S. A. and Hassan, R. A. Drug Misuse in the Treatment of Diarrhea among Children under Five Years; a Sample from Baghdad. IRAQI Journal of Community Medicine(2014), 27, 14-17.
Mahapatra, T., Mahapatra, S., Banerjee, B., Mahapatra, U., Samanta, S., Pal, D., Chakraborty, N. D., Manna, B., Sur, D. and Kanungo, S. Predictors of Rational Management of Diarrhea in an Endemic Setting: Observation from India. PLoS ONE, (2015)10, e0123479.
https://doi.org/10.1371/journal.pone.0123479
Nami Y, Haghshenas B, Abdullah N, Barzegari A, Radiah D, Rosli R, YariKhosroushahi A. Probiotics or antibiotics: future challenges in medicine. J Med Microbiol. 2015 Feb;64(Pt 2):137-146. https://doi.org/10.1099/jmm.0.078923-0. Epub 2014 Dec 18. PMID: 25525206.
Ogunleye O O, Fadare J O, Yinka-Ogunleye A F, AnandParamadhas B D, Godman B. Determinants of antibiotics prescribing among doctors in a Nigerian urban tertiary hospital. HospPract. 2018:1–6. https://doi.org/10.1080/21548331.2018.1475997.
Sanyaolu A, Okorie C, Marinkovic A, Jaferi U, Prakash S, et al., Global Epidemiology and Management of Acute Diarrhea in Children from Developing Countries. Ann Pediatr Child Health 2020; 8(8): 1205. https://doi.org/10.47739/2373-9312/1205
Savadogo L G, Ilboudo B, Kinda M, Boubacar N, Hennart P, Dramaix M, Donnen P. Antibiotics prescribed to febrile under-five children outpatients in urban public health services in Burkina Faso. Health. 2014 Jan 26;2014. https://doi.org/10.4236/health.2014.62026
Simpson, E., Zwisler, G. and Moodley, M. Survey of Caregivers in Kenya to Assess Perceptions of Zinc as a Treatment for Diarrhea in Young Children and Adherence to Recommended Treatment Behaviors. Journal of Global Health, (2013) 3, Article ID: 010403.
https://doi.org/10.7189/jogh.03.010405
Tekleab A M, Asfaw Y M, Weldetsadik A Y, Amaru G M. Antibiotic prescribing practice in the management of cough or diarrhea among children attending hospitals in Addis Ababa: a cross-sectional study. Pediatric Health Med Ther. 2017 Sep 19;8:93-98. https://doi.org/10.2147/PHMT.S144796.
World health organization (WHO), health topics available from https://www.who.int/health-topics/diarrhoea#tab=tab_1)
World Health Organization (WHO). Antibiotic resistance. WHO factsheets. http://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Accessed 28 Aug 2018.
World Health Organization. Antimicrobial resistance fact sheet. Geneva, 2017. (Available at: http://www.who.int/mediacentre/factsheets/fs194/en/) Accessed 13 Nov 2017.
World Health Organization. Global action plan on antimicrobial resistance. Geneva, 2015. (Available at: http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/) Accessed 13 Nov 2017.)