title: Prescription patterns and appropriateness of antibiotics in the management of cough/cold and diarrhea in a rural tertiary care teaching hospital.
abstract: BACKGROUND
  Acute gastroenteritis and respiratory illnesses are the major causes of morbidity and mortality in children under 5 years of age. The objective of this study was to evaluate the prescription pattern of antibiotic utilization during the treatment of cough/cold and/or diarrhea in pediatric patients.
  
  
  METHODS
  A descriptive, cross-sectional study was conducted for 6 months in pediatric units of a tertiary care hospital in South India. Children under 5 years of age presenting with illness related to diarrhea and/or cough/cold were included in this study. Data were collected by reviewing patient files and then assessed for its appropriateness against the criteria developed in view of the Medication Appropriateness Index and Guidelines of the Indian Academy of Pediatrics. The results were expressed in frequencies and percentages. Chi-square test was used to analyze the data. AP< 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 303 patients were studied during the study period. The mean age of the patients was 3.5 ± 0.6 years. The majority of children were admitted mainly due to chief complaint of fever (63%) and cough and cold (56.4%). The appropriateness of antibiotic prescriptions was higher in bloody and watery diarrhea (83.3% and 82.6%;P< 0.05). Cephalosporins (46.2%) and penicillins (39.9%) were the most commonly prescribed antibiotics, though the generic prescriptions of these drugs were the lowest (13.5% and 10%, respectively). The seniority of prescriber was significantly associated with the appropriateness of prescriptions (P< 0.05). Antibiotics prescription was higher in cold/cough and diarrhea (93.5%) in comparison to cough/cold (85%) or diarrhea (75%) alone.
  
  
  CONCLUSIONS
  The study observed high rates of antibiotic utilization in Chidambaram during the treatment of cough/cold and/or diarrhea in pediatric patients. The findings highlight the need for combined interventions using education and expert counseling, targeted to the clinical conditions and classes of antibiotic for which inappropriate usage is most common.
authors.affiliation: Department of Clinical Pharmacy, UCSI University, Kuala Lumpur, Malaysia.
authors.forename: Akram
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Clinical Pharmacy, UCSI University, Kuala Lumpur, Malaysia.
authors.forename: Muhammad Umair
authors.initials: MU
authors.lastname: Khan
authors.affiliation: Department of Internal Medicine, Swan Neelu Angel's Hospital, New Delhi, India.
authors.forename: Sadiqa
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Pharmacy Practice, Annamalai University, Tamil Nadu, Chennai, India.
authors.forename: Guru Prasad
authors.initials: GP
authors.lastname: Mohanta
authors.affiliation: Department of Pharmacy Practice, Annamalai University, Tamil Nadu, Chennai, India.
authors.forename: S
authors.initials: S
authors.lastname: Parimalakrishnan
authors.affiliation: Department of Biopharmaceutical Sciences, College of Pharmacy, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601, USA.
authors.forename: Isha
authors.initials: I
authors.lastname: Patel
authors.affiliation: Department of Pharmacy Practice, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
authors.forename: Sameer
authors.initials: S
authors.lastname: Dhingra
keywords: Appropriateness of antibiotics; children; cough/cold; diarrhea; drug utilization; prescription pattern