Antibiotic prescription patterns in paediatric wards of Rivers State university teaching hospital, southern Nigeria: a point prevalence survey

Antimicrobial resistance remains a threat to patient safety and healthcare outcomes and largely arises from inappropriate antimicrobial prescriptions. This study aimed to determine the pattern of antibiotic prescriptions in the Paediatrics department of Rivers State University Teaching Hospital, Port Harcourt.Method:A point prevalence survey was conducted in the Paediatric wards and Special Care Baby Unit (SCBU) on 13 November 2021. Records of all children admitted before or at 8:00a.m. on the day of the survey were descriptively analysed using the protocol and web-based management system of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp.Results: The antibiotic prevalence in this study was 77.4%. The most common indication(s) for antibiotic use in SCBU was infection prophylaxis (81.3%) and in paediatric wards: Pneumonia, Ear Nose Throat and Soft tissue infections accounted for (23.1%) each. Third-generation cephalosporins and aminoglycosides were predominantly used in all wards and were empirical-based prescriptions. Regarding antibiotic quality indicators of prescriptions: In SCBU: 19 (90.5%) had indication(s) for antibiotics documented, 10 (46.7%) were guideline compliant, and 1 (4.8%) had documented review/stop date. In the paediatric medical and surgical wards, 17(85.0%) vs. 4(100%) had indication(s) for antibiotics documented, 6(30.0%) vs. 0(0%) were guideline compliant, and 1(5.0%) vs. 4(100.0%) had a review/ stop date.Conclusion:High prevalence of antibiotic use, suboptimal antibiotic quality indicators and absence of laboratory evidence for antibiotic prescriptions were observed in the paediatric units. There is a need to reorientate prescribers and institute strategic measures to improve antimicrobial stewardship

Dialysis prescription: Determinants and relationship with intradialytic complications and the dialysis dose. A prospective study

Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients' characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose. Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson's correlation was used to determine the strength of association between dialysis dose and some variables. Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances). Conclusion: Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications

The North-East Moroccan physicians' management of menopause: Prescription vs. nonprescription of hormonal treatment

This study examined the management of North-East Moroccan physicians of menopause. The poll was carried out on a representative sample of physicians in the Nador region. The sample included gynecologists and general practitioner physicians in both public and private medical sectors. The survey contained focused and open-ended questions on the good knowledge or not of physicians about menopause, their patient population, their prescribing practices, their perceptions, and the different medical approaches to managing the symptoms of menopause. Among the general practitioners interviewed, only 16% of physicians are very knowledgeable about the management of menopause and only 3 physicians have followed continuous training. The others have mainly acquired their information from the internet, medical journals, and scientific magazines. Only one-third of physicians interviewed prescribe menopausal hormonal treatment in this region. The treatment is mainly prescribed to cope with hot flashes (97.1%) and menstrual cycle disruption (85.7%). Others are in favor of non-hormonal treatments and advise women to change their bad daily habits to relieve symptoms. In this region of Morocco, hormonal treatment for menopause is not very common and the majority of general practitioners are not familiar with menopause. (Afr J Reprod Health 2022; 26[6]:116-124).

Oxygen as a drug and scarce commodity: Do we use it rationally?

Medical grade oxygen is classified as a drug and needs to be prescribed by a qualified healthcare professional. Oxygen therapy is prescribed to people who cannot maintain normal blood oxygen saturation while breathing atmospheric air. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of the rational use of this scarce commodity. This study investigated oxygen therapy practices in adult ward patients. Methods: A cross-sectional study design with an analytical component was used in the adults' wards at a National District Hospital and the Pelonomi Academic Hospital in Bloemfontein. Data were collected from patient files, interviews and oxygen measurements of adult patients that received oxygen. Results: One hundred and fifteen patients were included in the study, of whom 47.0% received oxygen without an oxygen prescription. Around 62.3% of the patients with prescriptions did not receive oxygen as prescribed. The prescriptions and oxygen administration for COVID-19 patients were better than for non­COVID-19 patients. A quarter of the patients possibly received oxygen therapy unnecessarily. Conclusion: Poor oxygen therapy practices were identified, including prescription errors, oxygen administration errors and oxygen wastage. A protocol should be developed and implemented for the prescription and administration of oxygen therapy. Training should occur to prevent oxygen wastage. Contribution: This study highlighted poor oxygen practices and prescriptions, as well as oxygen wastage in the absence of local oxygen therapy guidelines.

Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals

Background: Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings. Methods: A cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence. Results: Completion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers' performance because of workload pressures. Conclusion: Low GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality

Antimicrobial prescription pattern in a tertiary hospital

Background: Antimicrobials are nonreplaceable in the treatment of bacterial infections and thus should be used judiciously. In Nigeria, there is currently no restriction on the prescription and sale of antimicrobials. This study was conducted to assess the antimicrobial prescription pattern of physicians at a tertiary hospital in Northwestern Nigeria. Materials and Methods: A point prevalence survey was carried out among all inpatients at Ahmadu Bello University Teaching Hospital in June 2015. Those receiving an antimicrobial agent during the survey period were included in the study while patients admitted on the day of the survey were excluded from the study. Data were obtained using a structured interviewer­administered questionnaire and abstraction from patient records. Information obtained included demographic data, antimicrobial agents prescribed, indication for treatment, laboratory data, and stop/review dates of prescriptions. Data were analyzed using SPSS version 20.0. Results: Twenty­three wards with a total number of 318 inpatients were enlisted. Of these, 210 (66%) patients were on treatment with antimicrobials. Male: female ratio of patients on antimicrobials was 1.2:1, and age of respondents ranged from 1 day (0.0027 years) to 75 years. The overall antimicrobial prevalence rate was 210 (66%) with surgical prophylaxis 100 (47.6%) as the most common indication. Overall, 332 antimicrobials were prescribed with cephalosporins as the most common class prescribed 96 (28.9%). Majority of the prescriptions (328, 98.8%) were based on empirical treatment, 288 (86.7%) were open prescriptions, and only 4 (1.2%) were according to treatment guidelines. Conclusion: The high prevalence of antimicrobial use highlights the need for an antimicrobial stewardship program in this facility

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals

Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province

Background: Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems.Objectives: This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape.Methods: A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge.Results: The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence.Conclusion: Training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice

Prescribing practices in the management of childhood diarrhoea in primary health care centres in a sub-urban community in Nigeria

Background: Childhood diarrhoea remains the second leading cause of morbidity and mortality among children under the age of five. Oral rehydration therapy and zinc tablets are the cornerstone for its management both at home and in the health facilities. Primary health care is the first level of contact of individuals and communities with the health care system and appropriate prescription is crucial for sustainable health benefits. This study assessed the prescribing pattern for childhood diarrhoea management and determined the appropriateness of treatment for acute watery diarrhoea without comorbidities in Primary Health Care (PHC) facilities in a sub-urban community in Nigeria.Methods: This descriptive study was done in 19 PHC facilities in Ikorodu Local Government Area of Lagos State, Nigeria. A retrospective review of 1271 prescriptions for diarrhoeal cases of children between 6 to 59 months was done using the records from the Outpatient Department register for a period of one year. Descriptive analysis was done. Results: From the cases reviewed, 1239 (97.5%) had acute watery diarrhoea (AWD), either alone 819 (64.4%), or with malaria/fever 347 (27.3%), cough/URTI 59 (4.6%), and other conditions 14 (1.1%). For cases of AWD alone, there were 499 (60.9%) prescriptions for ORS/Zinc, 249 (30.4%) for antibiotics and 203 (28.4%) for antimalarials. Antibiotic and antimalarial injections were also included in the prescriptions.Conclusion: This study found the prescription pattern for childhood diarrhoea to be inadequate with suboptimal prescriptions of ORS/Zinc. The prescriptions of antibiotics and antimalarials for acute watery diarrhoea was high and unnecessary

Evaluation de la prescription et de la délivrance des benzodiazépines dans la Survenue des addictions dans le district sanitaire de Mbour

Les benzodiazépines (BZD) sont très utilisées de nos jours et sont à l'origine d'uneaddiction.Objectifs : L'objectif était d'évaluer la qualité de la prescription et de la délivrance des benzodiazépines dans le département de Mbour au Sénégal et ultérieurement mettre en place une stratégie d'addictovigilance. Ainsi, nous avons étudié les habitudes de prescription, la qualité de délivrance et identifié les habitudes de consommation de ces médicaments. Matériels et méthodes : Il s'agissait d'une étude transversale, prospective avec deux questionnaires : adressé aux patients et prescripteurs, menée dans des pharmacies, hôpital, district et postes de santé de Mbour.Résultats:44% des ordonnanace de BZD étaient prescrites par des médecins et particulièrement des généralistes.31,1% ne respectaient pas les règles de prescriptions (hors AMM). Quant aux règles de délivrance,85,3% étaient délivrées sans ordonnance. Le niveau de consommation était élevé dans la tranche d'âge 30-40 ans (43,95%) avec une prédominance féminine (59%). L'insomnie prédominait comme motif de prescription (16,4%) sur l'anxiété (11,94%) avec (65,5%) de dépendance. Conclusion : Les abus observés dans la prescription, la délivrance et la consommation des BZD, constitue un véritable problème desantè.La moitié des consommateurs deviennent addictes, d'où la nécessité de mettre en place un programme d'addictovigilance à l'échelon national

Analyse de la prescription et de la réalisation des hémocultures au centre national hospitalier universitaire Hubert Koutoukou Maga de Cotonou

Introduction. Les états septiques sont associés à une morbidité et une mortalité importantes, surtout dans les pays à faible revenu. L'hémoculture est l'examen de choix pour le diagnostic de ces états mais en l'absence de recommandations claires à la disposition des praticiens dans les pays comme le Bénin, la pratique réelle de cet examen est mal connue. Objectif. Evaluer la prescription et la réalisation de l'hémoculture au Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM) de Cotonou. Matériel et méthodes. Il s'agissait d'une étude transversale qui s'est déroulée de février à juillet 2014.Elle a concerné les patients hospitalisés dans sept services à forte demande d'hémocultures du CNHU-HKM et a comporté deux volets : - un volet rétrospectif sur l'évaluation de la prescription de l'hémoculture, à partir des dossiers médicauxdes patients, - un volet prospectif sur l'évaluation des conditions de réalisation des hémocultures, sur la base de l'observation directe de la réalisation du prélèvement sanguin pour hémocultures.Résultats. Les taux de prescription et de réalisation des hémocultures chez les patients étaient respectivement de 62,8% et de 82,2%. Avant le prélèvement, la désinfection de la peau au niveau de la zone de ponction était réalisée chez tous les patients mais la désinfection des mains de l'infirmier et le nettoyage des bouchons des flacons d'hémoculture n'étaient réalisés que dans 61,4% et 49,7% des cas respectivement. Par ailleurs, 47,2% des patients avaient pris au moins une dose d'antibiotiques avant le prélèvement. Conclusion. Les conditions de prescription et de réalisation des hémocultures ne sont pas optimales au CNHU-HKM de Cotonou. Des mesures urgentes sont nécessaires dans cet hôpital pour améliorer la qualité de la prescription et de la réalisation de cet examen

Antiretrovirals and Co-Prescribed Drugs for People Living with HIV/AIDS (PLWHA) in a University Teaching Hospital; South West Nigeria

Background: Lifelong usage of antiretroviral drugs (ARVs) put them among the most therapeutically risky drugs for clinically significant drug interactions (CSDIs). It is; therefore; essential to document the types of antiretroviral (ARV) and non-ARV drugs co-prescribed (CPD) for PLWHA in order to facilitate the assessment of clinical significance of their interactions. Objectives: To document the most commonly prescribed ARV drugs and CPD among PLWHA and to assess the frequency of prescriptions of the first; second and third lines ART regimen. Methods: All the prescriptions received between January 2009 and June 2014 totaling 22;458 from 500 patients registered in APIN clinic in 2009; were reviewed with a view to documenting the most and the least prescribed CPD and ARV drugs. Results: Zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (4996/9302; 53.71%) was the most commonly prescribed ART regimen followed by tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) (1468/9302; 15.78%)and zidovudine/lamivudine/efavirenz (AZT/3TC/EFV) (683/9302; 7.34%). Abacavir/lamivudine/saquinavir/ritonavir (ABC/3TC (SQV/RTV) (1/9302; 0.01%) was the least prescribed ART regimen. The first line ART regimens (8574/9302; 92.17%) were mostly prescribed; followed by the second line (698/9302; 9.5%). Cotrimoxazole (7546/9302; 81.12%) was the most common non-ARV drug co-prescribed with ART regimen; followed by multivitamin (433/9302; 4.65%) and rifampin (316/9302; 3.40%). Conclusion: Co-trimoxazole was the most commonly co-prescribed non-ARV drug. Zidovudine/ lamivudine/nevirapine was the most commonly prescribed ART regimen. Considering the wide range of non- ARV drugs co-prescribed with ART regimens in this study; evaluation of their potential interactions is hereby suggested

Facility-Based Treatment of Under Five Diarrhoea in Cross River State: A Clinical Audit

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective; evidence- based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country.Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation.Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State; Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate; inappropriate; wrong or none; based on prescription on patients' case records.Result: Of the 370 case records audited; prescription for diarrhoea was appropriate in 40 (10.8%); inappropriate in 231 (62.4%); wrong in 82 (22.2%) and no prescription was made in 17 (4.6%).Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended

A snapshot of noncommunicable disease profiles and their prescription costs at ten primary healthcare facilities in the in the western half of the Cape Town Metropole

Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globally. It is thought that this increase will have the greatest impact on developing countries; such as South Africa; where it will adversely affect quality of life and increase healthcare costs. This research was conducted to determine the disease profile and cost of treating patients at 10 facilities in the western half of the Cape Town Metropole.Design: An analytical; cross-sectional study was carried out in order to interpret the cost of the medication in relation to the patient disease profile. Setting and subjects: Data were collected from 10 facilities in the western half of the Cape Town Metropole over a three-month period.Outcome measure: The outcome measure was the disease profile of patients attending the facilities and the cost of prescriptions for these patients.Results: Most patient visits to the community health centres were to treat chronic diseases (82). The disease profile of patients was as follows: 58.96 had hypertension; 19.67 diabetes; 12.14 asthma and chronic obstructive pulmonary disease; and 21.80 arthritis. It was found that 65 of patients with a chronic condition had co-morbidities. The cost of prescriptions was significantly higher (p-value 0.001) for chronic conditions than for acute conditions. The number of comorbidities per patient also influenced the cost of the prescriptions.Conclusion: The results indicated that most of the adults attending public sector facilities in the western half of the Cape Town Metropole have chronic diseases and that the cost of treating these conditions is significantly greater than that of treating acute conditions. An integrated approach to the management of chronic diseases is important in low-resource settings for the efficient utilisation of limited resources

Exercise Prescription in the Management of Rheumatoid Arthritis

"Background: Over the last few years; the types of exercises prescribed for patients with rheumatoid arthritis (RA) have changed. There is also increasing knowledge on the physical status and physical activity levels of these patients. This article aims to give an overview of the physical status; physical activity levels and appropriate exercise prescription for patients with RA. Method: A literature search was conducted of scientific journals and text; including Medline and PubMed (1980-2012). Literature was selected for its in-depth data and well researched information. Key search terms included ""RA and exercise therapy""; as well as ""physical activity levels and physical status of patients with RA"". Results: The literature indicated that RA has a major impact on physical and psychological health. Over the past decade; there has been growing evidence of the health benefits of physical activity for patients with RA. Despite this evidence; patients with RA are less physically active than the general population. The types of exercises prescribed for patients with RA have changed from the traditionally prescribed isometric and range-of-motion exercises. However; proper choice and appropriate utilisation of exercise is essential in order to provide a therapeutic effect. Conclusion: Although pharmacological interventions have largely improved RA management; exercise therapy remains an important part of treatment. Despite the known benefits of physical activity and exercise; patients with RA are less physically active than the general population."

Are Antiretrovirals Prescribed According to the Recommended Prescribed Daily Doses in the Private Healthcare Sector in South Africa

Current antiretroviral treatment (ART) guidelines recommend different combinations that have led to major improvements in the management of HIV and AIDS in the developed and developing world. With the rapid approval of many agents; health care providers may not be able to familiarise themselves with them all. This lack of knowledge leads to increased risk of dose- prescribing errors; especially by non-HIV and AIDS specialists. The purpose of this retrospective non-experimental; quantitative drug utilisation study was to evaluate if antiretrovirals (ARVs) are prescribed according to the recommended prescribed daily doses (PDDs) in a section of the private health care sector in South Africa (SA). Analysed ARV prescriptions (49995; 81096 and 88988) for HIV and AIDS patients were claimed from a national medicine claims database for the period 1 January 2005 through to 31 December 2007. ARV prescriptions prescribed by general practitioners (GPs) with PDDs not according to the recommended ARV dosing increased dramatically; from 12.33 in 2005 to 24.26 in 2007. Those prescribed by specialists (SPs) increased from 15.46 in 2005 to 35.20 in 2006 and decreased to 33.16 in 2007. The highest percentage of ARV prescriptions with PDDs not according to recommended ARV dosing guidelines was identified in ARV regimens with lopinavir-ritonavir at a PDD of 1066.4/264 mg and efavirenz at a PDD of 600 mg prescribed to patients in the age group of Group 3 (19 years age ? 45 years). These regimens were mostly prescribed by GPs rather than SPs. There is a need for more education for all health care professionals and/or providers in the private health care sector in SA on recommended ARV doses; to avoid treatment failures; development of resistance; drug-related adverse effects and drug interactions

Pre-hospital and prescription use of antibacterial drugs at a secondary health centre in Ibadan, Nigeria

The overall goal of this study is to reduce morbidity and mortality ascribable to bacterial infections by encouraging rational use of antibiotics. Antibiotics use prior to and prescriptions of antibiotics by the attending physicians were evaluated in a group of patients attending a secondary health facility. A quasi-exit interview was conducted using a structured questionnaire. The major presenting symptoms were sought from patients and/or parents and/or guardians; drug history was taken and doctors' prescriptions were copied onto an already prepared format. All data were entered into EPI-INFO version 6 for analyses. The mean age of patients who were enrolled was 14 ±±±± 16.96 [range: 0.08-78 years] but males patients were statistically younger than females: respectively 9.94 ±±±± 15.48 years (0.08-78 years) and 18.43 ±±±±17.10 years (range: 0.08 ­ 70 years); F: 122 P< 0.00. Pre-hospital use of antibiotics was documented in about a third of all the patients and cotrimoxazole was the most commonly used antibiotics accounting for 68.5% of antibiotics use in this group patients. Antibiotics were contained in more than half of all the prescriptions and erythromycin and cephalosporin were antibiotics of choice. This is contrary to the previous findings in the same area of study but different health facility. There is need for formulation of appropriate drug policy and establishment of continuing medical education for doctors as well as public enlightenment programmes on rational use of antibiotics

Prescription pattern of antimalarial drugs in children below 5 years in a tertiary health institution in Nigeria

Background: This study examines the diagnosis of malaria and pattern of prescription of antimalarial drugs in the most vulnerable age group (the under 5 children) in the study environment in order to identify the possible shortcomings and suggest solutions so as to improve the treatment outcome in future. Methods: The hospital records of 430 children with malaria infection admitted for treatment in a chosen tertiary health facility between January to December 2005 were selected for study. Forty-eight case records were excluded due to incomplete information. Data on demographic; clinical features of disease; diagnostic procedures; drug administration and the treatment out come were collected from the patients' records. Results: Analysis of the data revealed that more male (213) than female (169) children were admitted for malaria treatment: Fever with convulsion (55.8) was the commonest presenting symptoms; and anemia was the most frequent complications of malaria recorded. Chloroquine was found to be the most prescribed antimalarial agent and overall antemisinin-based drug was prescribed either as a first or second line treatment in only 18.2of the cases. The death rate recorded was 16. Conclusion: The pattern of antimalarial drugs prescription in the study center in most cases did not meet the recommended guidelines. The prescriptions were predominantly chloroquine; instead of artemisinin based. The death rate was comparatively high. Measures to raise the level of awareness among the practitioners on the current National policy on malaria treatment through seminars and workshops were suggested