A Point Prevalence Survey of Antibiotic Prescribing in three Nigerian public children's hospitals.
https://doi.org/10.51412/psnnjp.2023.9
Keywords:
Point Prevalence, Paediatric Wards, Neonatal, Resistance, Antibiotic prescribingAbstract
Background: Antibiotic resistance continues to impact public health globally hence the need to monitor antibiotic use in hospitals and in children in order to identify gaps in prescribing practices for possible intervention. This study investigated the prevalence and characteristics of antibiotic prescribing in three government hospitals in Lagos Nigeria in November/December 2015 using the Global point prevalence survey of antimicrobial consumption and resistance (G-PPS) as a tool. Data were analysed using the Statistical Package for Social Sciences (SPSS) software version 22. Results: Of the 207 inpatients, 180 (87%) were prescribed at least one antibiotic during the survey period. Furthermore, 81% and 89.3% of neonates and paediatric patients respectively were on antibiotics. The most commonly prescribed antibiotic class for neonates were the aminoglycosides (38.1%) and the third- generation cephalosporins (31%). In paediatric patients, the third-generation cephalosporins were the most prescribed (26.2%). Most common diagnosis in neonates was sepsis (38.3%) while lower respiratory tract infections (25.7%) were most occurring in paediatric patients. Community acquired infections were the most common indications for prescribing accounting for 48.8% and 56.6% of neonatal and paediatric prescriptions respectively. Overall, parenteral antibiotic accounted for 96.4% and 80.5% of antibiotics prescribed for neonates and paediatric patients. Targeted antibiotic prescribing was observed in 8.3% and 5.8% of neonatal and paediatric prescriptions. Furthermore, biomarker was used to guide prescribing in only 1.2 % of neonatal prescriptions. Antibiotic stop /review dates were documented in 11.9% and 12.5% of neonatal and paediatric prescriptions.
Conclusion: A high prevalence of antibiotic prescribing was observed in the surveyed children's hospitals. The high use of third generation cephalosporins, the predominant use of parenteral antibiotic formulations and the low documentation of stop review dates were among the identified areas for improving prescribing practices at these hospitals. The identified gaps can form the basis for implementing Antibiotic Stewardship Interventions in the hospitals of study.
References
Doron S and Davidson LE (2011) Antimicrobial Stewardship. Mayo Clinic Proceedings 86 (11): 1113–23 https://doi.org/10.4065/mcp.2011.0358
Mendelson M and Matsoso, MP(2015) The World Health Organization Global Action Plan for antimicrobial resistance. South African Medical Journal 105 ( 5 ) : 325 – 325 https://doi.org/10.7196/samj.9644
Varma JK, Oppong-Otoo J, Ondoa P, Perovic O, Park BJ, Laxminarayan R, Peeling RW, Schultsz C, Li H, Ihekweazu C, Sall AA, Jaw B, Nkengasong JN (2018) Africa Centres for Disease Control and Prevention's framework for antimicrobial resistance control in Africa. African Journal of Laboratory Medicine 7 ( 2 ) : 8 3 0 https://doi.org/10.4102%2Fajlm.v7i2.830
More, S.J. European perspectives on efforts to reduce antimicrobial usage in food animal production ( 2020 ) Irish Veterinary Journal 73 ( 2 ) https://doi.org/10.1186/s13620-019-0154-4
Nigeria country level report: Resource mobilization for antimicrobial resistance (2018) https://www.who.int/publications/m/item/nigeri a- country-level-report-resource-mobilisationfor-antimicrobial-resistance-(amr). Accessed September 2, 2021
Medernach RL and Logan LK (2018) The Growing Threat of Antibiotic Resistance in Children. Infectious Disease Clinics of North America 3 2 ( 1 ) : 1–17 https://doi.org/10.1016/j.idc.2017.11.001
Meropol SB, Haupt AA and Debanne SM (2018) Incidence and Outcomes of Infections Caused by Multidrug-Resistant Enterobacteriaceae in Children, 2007–2015. Journal of the Pediatric Infectious DiseaseSociety 7 ( 1 ) : 36 – 4 https://doi.org/10.1093/jpids/piw093
Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, Gittens-St Hilaire M (2020) Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infection and Drug Resistance 13:4713–38 https://doi.org/10.2147%2FIDR.S290835
Wei WJ, Yang HF, Ye Y, Li JB (2015) New Delhi Metallo-β-Lactamase-Mediated Carbapenem Resistance: Origin, Diagnosis, Treatment and Public Health Concern. Chinese Medical Journal (English) 128 ( 14 ) : 1969 - 76 https://doi.org/10.4103%2F0366-6999.160566
Egwuenu, A., Obasanya, J.O., Okeke, I.N., Aboderin, O.A., Olayinka, A.T., Kwange, D., Ogunniyi, A., Mbadiwe, E., Omoniyei, L., Omotayo, H., Niyang, M., Abba, F.Z., Kudla, F., Amr-Twg, & Ihekweazu, C (2018). Antimicrobial use and resistance in Nigeria: situation analysis and recommendations, 2017. The Pan African medical journal 8 (2)
Van Spreuwel PCJM, Blok H, Langelaar MFM, Kullberg BJ, Mouton JW, Natsch S (2015) Identifying targets for quality improvement in hospital antibiotic prescribing. The Netherlands Journal of Medicine 73(4):161–8
Centers for Disease Control and Prevention (2019) Core Elements of Hospital Antibiotic Stewardship Programs from the Centers for Disease Controland Prevention https : // www . cdc . gov/antibiotic - use/healthcare/pdfs/hospital-core- lementsH.pdf Accessed 20 December, 2020
Hsia Y, Lee BR, Versporten A, Yang Y, Bielicki J, Jackson C, Newland J, Goossens, H, Magrini N, Sharland M (2019) Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. The Lancet Global Health 7 ( 7 ) : e861 – 7 https://doi.org/10.1016/S2214-109X(19)30071- 3
Dramowski A, Velaphi S, Reubenson G, Bekker A, Perovic O, Finlayson H, Duse A, Rhoda NR, Govender NP (2020) National Neonatal Sepsis Task Force launch: Supporting infection prevention and surveillance, outbreak investigation and antimicrobial stewardship in neonatal units in South Africa. South African Medical Journal 110 ( 5 ): 360 – 3 https://doi.org/10.7196/samj.2020.v110i5.14564
Irwin A and Sharland M (2013) Measuring antibiotic prescribing in hospitalised children in resource-poor countries: Asystematic review. Journal of Paediatrics and Child Health. 49(3):185–92 https : // doi . org / 10 . 1111/ j . 1440 - 1754.2011.02126.x
Abdul-Nasiru S (2015) Rational Prescribing of Antibiotics in Children Under 5 Years with Upper Respiratory Tract Infections in Kintampo Municipal Hospital [Internet] [Thesis]. University of Ghana. http://ugspace.ug.edu.gh/handle/123456789/808 6Accessed 25 August 2021
Aregbeshola BS and Khan SM (2017) Primary Health Care in Nigeria: 24 Years after Olikoye Ransome-Kuti's Leadership. Front Public Health 5:48 https://doi.org/10.3389/fpubh.2017.00048
Global point prevalence surveys. Available from: https://www.global-pps.com/documents/ Accessed August 25, 2021
Oduyebo O O, Olayinka A T, Iregbu K C, Versporten A, Goossens H, Nwajiobi-Princewill P I, Jimoh O, Ige TO, Aigbe AI, Ola-Bello O I, Aboderin A O, Ogunsola F T (2017) A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals. Annals of Tropical Pathology 8:42-6 https://doi.org/10.4103/atp.atp_38_17
Umeokonkwo CD, Madubueze UC, Onah CK, Okedo-Alex IN, Adeke AS, Versporten A, Goossens H, Igwe-Okomiso D, Okeke K, Azuogu BN, Onoh R (2019) Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship. Journal of Global Antimicrobial Resistance 17:291- 295 https://doi.org/10.1016/j.jgar.2019.01.013
Abubakar U (2020) Antibiotic use among hospitalized patients in northern Nigeria: ad multicenter point-prevalence survey. BMC Infectious D i s e a s e s 3 0 ; 2 0 ( 1 ) : 8 6 https://doi.org/10.1186/s12879-020-4815-4
Sviestina I and Mozgis D (2014) Antimicrobial usage among hospitalized children in Latvia: A neonatal and pediatric antimicrobial point prevalence survey . Medicina 50 ( 3 ) : 175 – 8 1 https://doi.org/10.1016/j.medici.2014.08.005
Tribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, Kronman MP, Terrill KM, Sharland M, Newland J (2020) Appropriateness of Antibiotic Prescribing in United States Children's Hospitals: A National Point Prevalence Survey. Clinical Infectious Disease 71 ( 8 ) : e226 – 34 https://doi.org/10.1093/cid/ciaa036
Tersigni C, Montagnani C, D'Argenio P, Duse M, Esposito S, Hsia Y, Sharland M, Galli L (2019) Antibiotic prescriptions in Italian hospitalised children after serial point prevalence surveys (or pointless prevalence surveys): has anything actually changed over the years? Italian Journal of Pediatrics 45(1):127 https://doi.org/10.1186%2Fs13052- 019-0722-y
Gharbi M, Doerholt K, Vergnano S, Bielicki JA, Paulus S, Menson E, Riordan A, Lyall H, Patel SV, Bernatoniene J, Versporten A, Heginbothom M, Goossens H, Sharland M (2016) ARPEC project Group members. Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK. British Medical JournalOpen . 6 ( 11 ) : e012675 https://doi.org/10.1136/bmjopen-2016-012675
Versporten A, Sharland M, Bielicki J, Drapier N, Vankerckhoven V, Goossens H (2013) ARPEC Project Group Members. The antibiotic resistance and prescribing in European Children project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide. Pediatric Infectious Disease Journal 32(6): e242-53 https://doi.org/10.1097/INF.0b013e318286c612
Momanyi LB. (2017) Antibiotic Prescribing Patterns at Rift Valley Provincial General Hospital: A Point Prevalence Survey [Thesis]. University of Nairobi http://erepository.uonbi.ac.ke/handle/11295/102 500 Accessed 21 August 2021
Talaat M, Saied T, Kandeel A, El-Ata GA, ElKholy A, Hafez S, Osman A, Razik MA, Ismail G, ElMasry S, Galal R, Yehia M, Amer A, Calfee DP. A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt (2014) Antibiotics10;3(3):450-60 https://doi.org/10.3390/antibiotics3030450
Labi AK, Obeng-Nkrumah N, Nartey ET, Bjerrum S, Adu-Aryee NA, Ofori-Adjei YA, Yawson AE, Newman MJ (2018) Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey. Antimicrobial Resistance and Infection Control 7(1):15 https://doi.org/10.1186/s13756- 018-0299-z
Chukwu EE, Oshun PO, Osuolale KA, ChukaEbene VO, Salako A, Idigbe IE, Oladele D, Audu RA, Ogunsola FT (2021) Antimicrobial stewardship programmes in healthcare facilities in Lagos State, Nigeria: a needs assessment. Journal of Global Antimicrobial Resistance25 : 1 62 -170 https://doi.org/10.1016/j.jgar.2021.02.034
Gandra S, Alvarez-Uria G, Murki S, Singh SK, Kanithi R, Jinka DR, Chikkappa AK, Subramanian S, Sharma A, Dharmapalan D, Kandraju H, Vasudevan AK, Tunga O, Akula A, Hsia Y, Sharland M, Laxminarayan R (2018) Point prevalence surveys of antimicrobial use among eight neonatal intensive care units in India: International Journal of Infectious Diseases . 7 1 : 2 0 - 2 4 https://doi.org/10.1016/j.ijid.2018.03.017
Labi AK, Obeng-Nkrumah N, Sunkwa-Mills G, Bediako-Bowan A, Akufo C, Bjerrum S, Owusu E, Enweronu-Laryea C, Opintan JA, Kurtzhals JAL, Newman MJ (2018) Antibiotic prescribing in paediatric inpatients in Ghana: a multi-centre point prevalence survey. Biomed Central Pediatrics 18(1):391 https://doi.org/10.1186/s12887-018- 1367-5
Sharma M, Damlin A, Pathak A, Stålsby Lundborg C (2015) Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India. PLoS One ; 10 ( 11 ) : e0142317 https://doi.org/10.1371%2Fjournal.pone.014231 7
Hufnagel M, Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H; ARPEC Project Group (2019) High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results from the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey. Journal of Pediatric Infectious Diseases Society 8(2):143-151 https://doi.org/10.1093/jpids/piy01
Mustafa ZU, Khan AH, Salman M, Syed Sulaiman SA, Godman B (2022) Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children's Hospitals in Punjab, Pakistan. Antibiotics 11(8):1056 https://doi.org/10.3390/antibiotics11081056
Heginbothom M, Sullivan J, and Howe R (2019)Point Prevalence Surveys of Antimicrobial Prescribing in Acute Hospitals in Wales 2013-2018 https: / / phw. nhs. wales/s ervices- and - teams/harp/antimicrobial-resistance-andprescribing-surveillance-and- reports/acutehospitals-quality-measures-report-for-2013- 2018-antimicrobial-pps-v1/ Accessed 3, September, 2019
Okoth C, Opanga S, Okalebo F, Oluka M, Baker Kurdi A, Godman B (2018) Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications. Hospital Practice 46 ( 3 ) : 128 - 136 https://doi.org/10.1080/21548331.2018.146487 2
Meyer E, Schwab F, Schroeren-Boersch B, Gastmeier P (2010) Dramatic increase of thirdgeneration cephalosporin-resistant E. coli in
German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001 to 2008. Critical Care14 ( 3 ) : R113 https://doi.org/10.1186%2Fcc9062
World Health Organization. Regional Office for South-East Asia. Step-by-step approach for development and implementation of hospital and antibiotic policy and standard treatment guidelines https://apps.who.int/iris/handle/10665/205912
Fahimzad A, Eydian Z, Karimi A, Shiva F, Sayyahfar S, Kahbazi M, Rahbarimanesh A, Sedighi I, Arjmand R, Soleimani G, Sanaei Dashti A, Abdinia B, Mostafavi N, Nikfar R, Abedini M, Rezaei MS, Mohammadpour A, Hashemian H, Hidari H, Ghadiri K, Entezari Heravi R (2014) Surveillance of antibiotic consumption point prevalence survey 2014: Antimicrobial prescribing in pediatrics wards of 16 Iranian hospitals. Archives of Iranian Medicine 19(3): 204 – 209
Fahimzad A, Eydian Z, Karimi A, Shiva F, Armin S, Ghanaei RM, Fallah F, Tabatabaii SR, Shivrani R, Rahbar M, Sayyahfar S, Kahbazi M, Rahbarimaneh A, Arjmand R, Dashti AS, Abdinia B, Abedini M, Hidari H, Ghadiri K, Sharif A, Shahri ES, Shariat Z, Nejedian A, Moshayedi M, Fatholapoor S, Alizaden H, Heravi RE (2017) Antibiotic Prescribing Pattern in Neonates of Seventeen Iranian Hospitals Archives of Pediatric Infectious Disease 5(4): e61630 https://dx.doi.org/10.5812/pedinfect.6163
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 The Nigerian Journal of Pharmacy
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
