title: [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital].
abstract: OBJECTIVE
  Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units.
  
  
  METHODS
  A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed.
  
  
  RESULTS
  A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009).
  
  
  CONCLUSIONS
  Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.
authors.affiliation: Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. sruvinsky@hotmail.com
authors.forename: Silvina
authors.initials: S
authors.lastname: Ruvinsky
authors.forename: Andrea
authors.initials: A
authors.lastname: Mónaco
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Pérez
authors.forename: Moira
authors.initials: M
authors.lastname: Taicz
authors.forename: Laura
authors.initials: L
authors.lastname: Inda
authors.forename: Ivana
authors.initials: I
authors.lastname: Kijko
authors.forename: Patricia
authors.initials: P
authors.lastname: Constanzo
authors.forename: Rosa
authors.initials: R
authors.lastname: Bologna
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001118:Argentina; D001291:Attitude of Health Personnel; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data; D008297:Male; D009042:Motivation; D009369:Neoplasms / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications; D009503:Neutropenia / Q000150:complications; D010820:Physicians / Q000523:psychology*; D011183:Postoperative Complications / Q000188:drug therapy; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents