Pattern of inappropriate antibiotic use among patients in the medical wards of a tertiary hospital in southwest Nigeria

Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.

Provenance des prescriptions de médicaments reçues dans les officines de pharmacie du Département de Dakar / Origin of drug prescriptions received in pharmacies in the Department of Dakar

Introduction. L'accessibilité à des médicaments de qualité constitue un véritable problème de santé publique en Afrique. Cela est dû à des besoins énormes en soins de santé associés à des ressources limitées. La prescription de médicaments qui est un acte médical pour traiter les malades après avoir posé le diagnostic, est réservée aux professionnels de santé. L'objectif de ce travail est d'étudier la provenance des prescriptions de médicaments reçues dans les officines de Dakar. Matériels et méthodes. Il s'agit d'une étude descriptive et transversale. Elle porte sur l'exploitation de prescriptions médicales reçues dans des officines du département de Dakar. Résultats. Les résultats révèlent que plus de la moitié des prescriptions soit 61%, provient du secteur privé et 30.52% sont faites par des médecins généralistes. De plus, la classe de la parasitologie et infectiologie est la plus prescrite (18.26%). Conclusion. L'analyse de ces paramètres nous aide à mieux évaluer la situation sanitaire pour estimer les besoins en médicaments et ainsi faire des recommandations pour une meilleure accessibilité.

Introduction. Accessibility to quality drugs is a real public health problem in Africa. This is due to huge health care needs associated with limited resources. The prescription of drugs, which is a medical procedure for treating patients after having made the diagnosis is reserved for health professionals. The objective of this work is to study the origin of prescription of drugs received in the pharmacies of Dakar. Materials and methods. This is a descriptive and cross-sectional study. It is based on the use of medical prescriptions received in pharmacies in the department of Dakar. Results. The result reveal that more than half of the prescriptions are 61%, come from the private sector and 30,52% are made by general practitioners. In addition, the class of parasitology and infectiology is the most prescribed (18,26%). Conclusion. The analysis of these parameters helps us to better assess the health situation in order to estimate the drug needs and thus make recommendations for a better accessibility.

Prise en charge des patients atteints de COVID 19: analyse des prescriptions médicamenteuses au CHU Gabriel Touré / Management of patients with Covid 19: analysis of prescription drugs at Gabriel Touré University Hospital

La COVID-19 est une infection virale qui s'est propagé dans tout le monde. Pour la prise en charge des cas, le Mali a créé des sites de traitement dont celui du CHU Gabriel Touré. Objectif : C'était d'analyser les prescriptions médicamenteuses pour le traitement de la COVID-19 au CHU Gabriel Touré. Méthodologie : L'étude était rétrospective et descriptive et a concerné la période d'avril à septembre 2020. Elle s'est déroulée au Centre de Traitement COVID-19 du CHU Gabriel Touré et à la Pharmacie Hospitalière de cet hôpital. Les ordonnances et les registres d'hospitalisation ont servi à collecter les données. Résultats : Au total, 29 patients ont été hospitalisés. L'âge médian était de 44ans, 75,90% des patients présentaient au moins une pathologie associée à la COVID-19. Le nombre d'ordonnances était de 333 comportant 870 lignes de prescriptions dont 33,21% de traitements standards et 66,79% pour les pathologies associées avec 86,23% disponibles à la Pharmacie Hospitalière. Le phosphate de chloroquine, dosé à 250mg, était administré à 500mg deux fois quotidiennement. Dans les directives nationales le phosphate de chloroquine était à 100mg pour 200mg trois fois quotidienne. La vitamine C non prévue dans les directives a été prescrite à tous les patients. La classe des médicaments du sang et des organes hématopoïétiques a été les plus prescrits (31,49%). Le coût moyen des traitements était de 65602±106858 FCFA avec maximum de 567860 FCFA. Une évaluation des prescriptions dans les autres sites de traitement est nécessaire.

COVID-19 was declared a pandemic in March 2020. For case management, Mali has created several treatment sites including the site of the CHU Gabriel Touré. Aims: The objective of the study was to analyse drug prescriptions for the COVID-19 treatment at the CHU Gabriel Touré. Methods: We performed a retrospective and descriptive study from April to September 2020. Drug prescriptions and hospital records were used to collect data. Prescriptions and hospital records were used to collect data. Results: A total of 29 patients were hospitalized. The median age was 44 years, 75.90% of patients had at least one pathology associated with COVID-19. The number of prescriptions was 333 comprising 870 lines of prescriptions including 33.21% for standard treatments, and 66.79% for associated pathologies. with 86.23% available at the Hospital Pharmacy. Chloroquine, dosed at 250mg, was administered at 500mg twice a day. The national guidelines from the treatment of COVID19 recommends 200mg of chloroquine in two doses. Vitamin C was prescribed for all patients although not included in the national guidelines. The class of drugs for the blood and blood-forming organs was the most prescribed (31.49%). The average cost of treatments was 65,602 ± 106,858 FCFA with a maximum of 567,860 FCFA. An evaluation of prescriptions in other treatment sites is necessary.

Evaluation of prescription pattern of analgesic use among ambulatory elderly in South-Western Nigeria

Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival

Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa

Background: Costly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.Aim: This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments. Setting: The study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa.Methods: An exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators ­ one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes.Results: Co-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes' function.Conclusion: Unavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments

Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis

Background. Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis.Objective. To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis.Methods. The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed.Results. Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams.Conclusions. Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics

Prevalence and antibiotic susceptibility pattern of esbl producing klebsiellae isolated from clinical specimens in a nigerian tertiary hospital

Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria. Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified Kirby-Baeur method with the organism tested against ceftazidime (30µg), cefotaxime (30µg), amoxicillin clavulinic acid (20/10µg), cefepime (30µg), ciprofloxacin (5µg), gentamicin (10µg), trimethoprim-sulphamethoxazole (23.75/1.25µg), imipenem (10µg) and doripenem (10µg) (Oxoid, UK). Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem. Conclusion: The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies

Evaluation of Outpatient Prescriptions in a University-Based Healthcare Facility in Ibadan

Background: Appropriate drug utilization has a huge contribution to global reduction in morbidity and mortality. Periodic review of prescriptions at all levels of care is therefore essential. Objective: To evaluate drug prescription pattern and practice in a university-based healthcare facility using the WHO-core prescribing indicators.Method: A retrospective review of randomly selected outpatient prescriptions in the pharmacy unit of the University of Ibadan Health Services between 2012 and 2014 was done. Pre-piloted data collection form was used to retrieve data based on standard prescription specifications including socio-demographics; drug name and dosage regimen; and prescriber identity. Descriptive statistics were used to summarize the data. Results: A total of 4;121 medicines were reviewed in 1200 encounters. Of these; 589 (49.1%) were prescribed for males and 611 (50.9%) for females. Patients' ages were indicated in 388 (32.3%) prescriptions (mean age =17.7years). Summary of WHO-core prescribing indicators showed the average number of medicines per encounter as 3.4; medicine prescribed by generic name (2;533; 61.5%); encounter with one or more antibiotics and injections (427; 35.6%) and (150; 12.5%); respectively. Conclusion: Polypharmacy; low generic prescribing and overuse of antibiotics is common underscoring the need for ongoing enlightment and training of healthcare providers on rational prescribing practice and drug use

Pharmacist Prescribing in the United Kingdom and the Implication for the Nigerian Context

Background: Non-medical professionals including pharmacists have been granted the right to prescribe medicines in the United Kingdom. In Nigeria; only medical doctors; dentists and some nurses in primary care facilities have the legal right to prescribe medicines and patients' access to prescriptions can be seriously affected by a shortage of prescribers and long waiting times in hospitals.Objective: This article presents a review of pharmacist prescribing in the UK including its model; impact; facilitators and barriers and discusses the implications for the Nigeriancontext. Methods: A literature search was conducted in Medline; Embase; International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature databases for studies investigating pharmacist prescribing in the UK between 1990 and August 2013.Results: The review identified that legislative change in the UK has enabled pharmacists to prescribe first as supplementary prescribers then as independent prescribers. This policy change was driven by the desire to increase patients' access to medicines and promote the utilisation of the skills of non-medical professionals while maintaining patient safety. Although more robust research evidence is needed to demonstrate the effectiveness of pharmacist prescribing; available evidence shows that it has had an impact on patient access to medicines.Conclusion: Pharmacist prescribing has the potential to promote access to prescription medicines; free doctors' time to enable them deal with complex cases and promote efficient use of pharmacists' clinical skills in Nigeria as it does in the UK. Factors which can promote the extension of prescribing rights to pharmacists in Nigeria include the current level of pharmacists' training and the clinical roles of pharmacists in some tertiary hospitals

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting

Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established. Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established

Cost Minimization Analysis of Antibacterial Therapy in a Developing Country

Background: There is the need for improved efficiency and minimization in cost of antibacterial therapy in developing countries. The study objective was to carry out cost minimisation analysis of antibacterial in a tertiary health care facility in Nigeria between the year 2005 and 2006. Methods: Drug utilization review was carried out using prescriptions in 525 consecutively sampled case notes of some infectious diseases retrospectively. Relevant data such as demographics; diagnosis; prescribed drugs; and dosages were extracted. Cost per defined daily dose of each drug; the cost of each prescription and theaverage cost of antibacterial agents per patient were determined. This was followed by economic evaluation using Cost Minimization Analysis. Data were analysed appropriately. Results: Amoxicillin and coamoxiclav for ENT infections and ciprofloxacin/doxycycline for STIs were the mostwidely utilized. Generic products; higher strength; solid dosage forms and oral formulations are more costeffective than branded agents; lower strength; liquid formulations and injections of the same drug entityrespectively. For instance; the use of generic product of ciprofloxacin for 5 days for 1000 patients (5000DDDs) resulted in a cost saving of NGN1.04million (USD9;333.33). Conclusion: Only few drug items were predominantly responsible for high antibacterial therapy costs which need to be closely monitored for cost to be appreciably minimized. Generic antibacterial agents; higher strength preparations of the same drugs; solid forms in preference to syrups among school age children andoral agents in preference for injection should be used. Significant cost could be minimised and improved accessto essential drugs assured if these are followed

Drug Use Pattern with Standard Indicators in Jos University Teaching Hospital Nigeria

Background: Drug use pattern is assessed through prescribers; dispensers; and patients.The indicators used formonitoring include; health-facility; prescribing and patient care indicators. Objectives: The study was aimed at determining the drug use pattern by measuring core indicators in Jos University Teaching Hospital (JUTH); Nigeria; from 2010 to 2011; and to compare findings with similar institutions globally.Methods: Drug-specific analysis employed research tools using nine-item questionnaires; checklists and standard patient care forms. Data was obtained from patients who visited the hospital; within the period of thisstudy.Results: The study revealed that out of the total drugs prescribed; 85.3 were dispensed and the average number of drugs per prescription was three. About 70.2 of drugs were prescribed by generic names while therest were by brand names. Drugs prescribed from the hospital formulary were 88 with antibiotics being themost prescribed (35.3) while the least prescribed were injections (9) with no significant variation (p0.05)for the indicators measured during the period. Responses to questions on drug use produced positive results(85) in six out of the nine research items. Average consultation time was 11.33 minutes and dispensing timegave 3.53 minutes.Conclusion: The drug use pattern in JUTH was satisfactory compared to national and international findings. The core indicators measured underscored the need for pharmacists to provide drug information and counseling needs to patients and could serve as basis for further studies on drug use for hospitals in resource limited settings. Conclusion: The drug use pattern in JUTH was satisfactory compared to national and international findings. Thecore indicators measured underscored the need for pharmacists to provide drug information and counseling needs to patients and could serve as basis for further studies on drug use for hospitals in resource limited settings

Assessment of Disease Profiles and Drug Prescribing Patterns of Health Care Facilities in Edo State; Nigeria

Few studies have systematically characterized drug-prescribing patterns; particularly at the primary care level in Nigeria; a country disproportionately burdened with disease. The aim of this study was to assess the disease profiles and drug-prescribing pattern in two health care facilities in Edo State; Nigeria. The medical records of 495 patients who attended a primary or secondary health care facility in Owan-East Local Government Area of Edo State; Nigeria; between June and November 2009 were reviewed. Disease profiles and drug prescribing patterns were assessed. Data were analyzed based on the World Health Organization Anatomic Therapeutic Chemical classification system; and core drug prescribing indicators. Five hundred and twelve clinical conditions were identified. Infectious disease was most prevalent (38.3); followed by disorder of the alimentary tract (16.4). Malaria was responsible for 55.6 of the infectious diseases seen; and 21.3 (109/512) of the total clinical conditions managed at the two health facilities during the study period. Consequently; anti-infective medications were the most frequently prescribed medicines (21.5); followed by vitamins (18.2). Use of artesunate monotherapy at both facilities (15.7); and chloroquine at the primary health facility (24.9) were common. Paracetamol (41.8) and non-steroidal anti-inflammatory drugs (24.9) were the most frequently used analgesic/antipyretic. At the primary health care facility; dipyrone was used in 21.6 of cases. The core drug prescribing use indicators showed inappropriate prescribing; indicating poly-pharmacy; overuse of antibiotics and injectio. Inappropriate drug use patterns were identified at both health care facilities; especially with regard to the use of ineffective antimalarial drugs and the use of dipyrone

Ambiguous Diagnosis; Futile Treatments and Temporary Recovery: Meanings of Medical Treatment Among HIV/AIDS Family Caregivers Providing Care without ARVs

The capacity of countries with high HIV and AIDS prevalence to provide antiretroviral treatment and care for all people who need support remains a public health challenge. In Lesotho; there are improvements in this area but the high proportion of people who need ART yet they do not receive treatment suggests that many HIV-infected people continue to depend on medicines that treat opportunistic infections. The objective of the article is to explore caregivers' experiences with diagnostic procedures and outcomes; prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving; including access to and use of medical treatments. Caregivers' experiences indicate that most of the consulted health professionals provided vague and inconsistent diagnoses while the medication they prescribed failed to treat most of the symptoms. Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV and AIDS care

Prescribing patterns of medicine classified as 'antidepressants' in South African children and adolescents

The main objective of this study was to characterise prescribing patterns of medicine classified as 'antidepressants' (hereafter simply referred to as antidepressants) in children and adolescents in the private health care sector of South Africa. A retrospective drug utilisation design was used to identify patients aged 19 years and younger from a South African pharmaceutical benefit management company's database; whom were issued at least one antidepressant between 1 January 2006 and 31 December 2006. Prescribed daily dosages (PDDs) were calculated using the Statistical Analysis Systemr program. A total of 1 013 patients received a mean number of 2.88 (SD 3.04) prescriptions per patient. Females received more prescriptions than their male counterparts; with the highest prevalence in the 15 = 19 years age group. The pharmacological groups most prescribed were the selective serotonin reuptake inhibitors (43.0) and the tricyclics (42.7); with imipramine (22.04) and amitriptyline (19) as the most commonly prescribed drugs. Approximately 30(n = 2 300) of all antidepressants in the study population were prescribed off-label. Amitriptyline and clomipramine were prescribed at daily dosages higher than recommended in children and adolescents aged 9 = 15 years. Lithium; trimipramine; trazodone and sulpiride were prescribed at sub-therapeutic dosages in adolescents. This study provided insight in the prescribing patterns of medicine classified as antidepressants in South African children and adolescents. These drugs; however; have many indications. Further research is needed to determine reasons why specific drugs are prescribed in this population