Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country.
BACKGROUND
Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important.


OBJECTIVE
To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital.


METHODS
Retrospective review of medical records of all children (age 1 month-16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19.


RESULTS
All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1-7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h.


CONCLUSIONS
This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.
Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
Qalab
Q
Abbas
Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
Anwar
A
Ul Haq
Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
Raman
R
Kumar
Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
Syed Asad
SA
Ali
Department of Pharmacy, Aga Khan University, Karachi, Sindh, Pakistan.
Kashif
K
Hussain
Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
Sadia
S
Shakoor
Antibiotic use; Pediatric Intensive Care Unit; developing country; infection