Antibiotic prescribing patterns in the pediatric emergency department at Georgetown Public Hospital Corporation: a retrospective chart review.
BACKGROUND
The increase in antimicrobial-resistant infections has led to significant morbidity, mortality, and healthcare costs. The impact of antimicrobial resistance is greatest on low-income countries, which face the double burden of fewer antibiotic choices and higher rates of infectious diseases. Currently, Guyana has no national policy on rational prescribing. This study aims to characterize antibiotic prescribing patterns in children discharged from the emergency department at Georgetown Public Hospital Corporation (GPHC), as per the World Health Organization (WHO) prescribing indicators.


METHODS
A retrospective chart review of pediatric patients (aged 1 month-13 years) seen in the GPHC emergency department between January and December 2012 was conducted. Outpatient prescriptions for eligible patients were reviewed. Patient demographics, diagnosis, and drugs prescribed were recorded. The following WHO Prescribing Indicators were calculated: i) average number of drugs prescribed per patient encounter, ii) percentage of encounters with an antibiotic prescribed, iii) percentage of antibiotics prescribed by generic name, and iv) percentage of antibiotics prescribed from essential drugs list or formulary.


RESULTS
Eight hundred eleven patient encounters were included in the study. The mean patient age was 5.55 years (s = 3.98 years). 59.6 % (n = 483) patients were male. An average of 2.5 drugs were prescribed per encounter (WHO standard is 2.0). One or more antibiotic was prescribed during 36.9 % (n = 299) of all encounters (WHO standard is 30 %). 90.83 % of antibiotics were prescribed from the essential drugs formulary list and 30 % of the prescriptions included the drug's generic name. The average duration of antibiotic therapy was 5.73 days (s = 3.53 days). Of the 360 antibiotics prescribed, 74.7 % (n = 269) were broad-spectrum. B-lactam penicillins were prescribed most frequently (51.4 %), with amoxicillin being the most popular choice (33.9 %). The most common diagnoses were injuries (25.8 %), asthma (20 %), respiratory infections (19.5 %), and gastrointestinal infections (12.1 %).


CONCLUSIONS
Per WHO prescribing indicators, the pediatric emergency department at GPHC has higher than standard rates of antibiotic use and polypharmacy. The department excels in adhering to the essential drug formulary. Our findings provide support for investigating drug utilization in other Guyanese settings, and to work towards developing a national rational prescribing strategy.
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. suparna.sharma@mail.utoronto.ca.
Suparna
S
Sharma
Department of Pediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana.
Clive
C
Bowman
Department of Pediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana.
Bibi
B
Alladin-Karan
Department of Pediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana.|Department of Pediatrics, Humber River Regional Hospital, Toronto, Canada.
Narendra
N
Singh
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000188:drug therapy*
D000900:Anti-Bacterial Agents
Antimicrobial resistance; Global health; Pediatrics; Rational prescribing