title: Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India.|Department of Public Health Sciences, Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden.
authors.forename: Megha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Public Health Sciences, Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Damlin
authors.affiliation: Department of Public Health Sciences, Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden.|Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India.|Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, SE 751 85 Uppsala, Sweden.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Department of Public Health Sciences, Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Stålsby Lundborg
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D017149:Private Sector; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014435:Typhoid Fever / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents