Résumé
Background: Pediatric diarrhea is the 3rd foremost cause of childhood mortality all over the world. Although these are self-limiting, irrational antibiotic use and polypharmacy are prevalent in their treatment. Antimicrobial therapy is recommended in bacterial diarrhea and severely malnourished children only. Inappropriate use of drugs for the treatment of acute diarrhea can be minimized by adhering to standard guidelines. Aims and Objectives: The objectives of this study were as follows: (1) To evaluate the appropriateness of drug treatment in Acute Pediatric Diarrhea and (2) to assess the appropriateness of antibiotic treatment in diarrhea based on modified Kunin’s criteria. Materials and Methods: A prospective observational study was conducted for 12 months at the pediatric inpatient unit of Bidar Institute of Medical Sciences, Bidar. Prescriptions of 400 cases of acute diarrhea were evaluated for the appropriateness of drug usage using Indian Academy of Pediatrics (IAP) guidelines and modified Kunin’s criteria. Results: Among the 400 acute diarrhea cases, majority were male (54.75%) and below 5 years (58.25%). Oral rehydration solution (ORS) was given to 337 patients and IV fluids to 324 cases. About 55.5% patients were prescribed antibiotics. In 75.67% prescriptions, the antibiotic use was not necessary (modified Kunin’s criteria category V). Only 12.5% prescriptions adhered to IAP guidelines (2006), which included ORS and Zinc. About 54.5% patients were prescribed probiotics and 80% were prescribed antiemetics (ondansetron), which is not appropriate as per guidelines. Conclusion: Majority of patients were prescribed ORS, but only few were given zinc as an adjunctive therapy. Thus, we found that adherence to IAP 2006 guidelines was very low in our setup. Based on our observations, we suggest that prescribers should make use of standard treatment guidelines and choose appropriate drugs and their formulations so that irrational use of drugs can be minimized.
Résumé
Background: To evaluate prescribing pattern of antimicrobial agents in indoor patients of medicine and surgery department of SBH Government Medical College, Dhule. Methods: This was a retrospective cross sectional study carried over a period of 3 months. The patients who were admitted and received antimicrobial therapy in department of Medicine and Surgery were randomly selected and included in the study. The case record sheet and drug chart were obtained from Medical Record Section of the Hospital. The data was collected using case record form specially prepared for the study. The cases were categorised according to slightly Modified Kunin’s Criteria. Results: Total numbers of patients receiving antimicrobial therapy were 130 in medicine department and 93 in surgery department. Most commonly prescribed antimicrobial agent was cefotaxime (21.7%) in medicine and metronidazole in surgery (30.6%) department. The average number of antimicrobials per patient was found to be 1.7 and 3.02 in medicine and surgery department respectively. The switch on therapy from parenteral to oral route was employed in 16.15% patients in medicine department and 11.82% patients in surgery department. As per Kunin’s modified criteria, 66.2% and 58.06% patients received antimicrobial therapy appropriately in Medicine and surgery department respectively. Conclusion: This study highlights the problem of over-prescription of antibiotics and a trend towards polypharmacy. The interventions to rectify the problem of inappropriate use of antimicrobial agents are needed to make therapy more rational and cost effective.