ABSTRACT
Background: The success of standardized measures for disease classification and treatment has led disease-specific approaches led WHO and UNICEF to incorporate them into a set of guidelines for the integrated management of childhood illness [IMCI], which includes modules or subsets of guidelines for the recognition and management of children with acute respiratory infections, diarrhea, measles, malaria and other febrile illness, and malnutrition
Objective: To assess the use of antibiotics within the IMCI Guidelines in Pediatric Outpatient Settings of Jinnah Hospital
Methodology: It was a cross-sectional study conducted at Pediatrics OPD Jinnah Hospital from May 1, 2014 - August 21, 2014. The 150 children and their parents / accompanying person fulfilling the inclusion criteria after consultation from pediatric consultation were interviewed regarding their disease status and prescription by the doctor regarding antibiotics and other conditions. All the information was entered in a structured questionnaire. The samples were collected by non-probability / purposive sampling technique
Results: Among 150 children included in study mean age of children was 36 months SD 20.42 months. 60% were male and 40% female. Presenting complaints among children were, 75.0% presented fever, 26.4% had loose motions, 22.3% has vomiting, 20.3% had cough. 12.8% presented with abdominal pain. Among those who received antibiotics, 10% received third generation cephalosporin [ceftriaxone, cefexime], 10.7% penicillin's [mostly amoxicillin and piperacillin], and 4% ciprofloxacin. 30% received combination of 2 or 3 antibiotics [14.7% combination of ceftriaxone and amikacin [aminoglycoside], According to IMCI guidelines 34% were not appropriately treated, 20.7% received antibiotics when they should not and 13.3% did not received antibiotics when they should have
Conclusion: Their low adherence to integrated management of childhood illness [IMCI] recommendations for prescription of antibiotics in routine outpatient settings the study shows highly prevalent use of third generation cephalosporins
ABSTRACT
A comparative double blind study of Ketamine and Morphine was conducted on eighty children following tonsillectomy to assess the analgesic, respiratory rate depressant and emesis. Children [6-12 years] were divided into two groups randomly [n=40]. General anesthesia was induced followed by 0.1mg/kg morphine [I/M] and 0.5mg/kg ketamine [I/M] to Group I and Group II respectively before the initiation of surgical procedure. Pain scores [face score and CHEOPS score] were estimated for children at thirty, sixty, one hundred and twenty and two hundred and forty minutes following surgery. Comparison of CHEOPS score estimation reflected that pain scores were statistically significant [P < 0.05] in Group I receiving Morphine as compared to Group II who received Ketamine. The analgesic effect of ketamine and morphine showed statistically insignificant results [P>0.05] in case of face score. Moreover, respiratory rate in Group I had shown statistical association [p<0.05] as compared to the ketamine at 60 and 120 minutes. Furthermore, incidence of vomiting was more in Group I [0.05] as compared to Group II. It can be concluded from the study that ketamine may be used as a suitable substitute to that of morphine in children undergoing tonsillectomy