Outpatient prescribing and antibiotic use for children in a tertiary hospital

Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2­year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20 (IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic­containing prescriptions had one antibiotic prescribed while ß­lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing

Severe necrotising pneumonia in a toddler: A rare presentation with dual bacterial aetiology.

Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.

Prescribing pattern and antibiotic use for hospitalized children in a Northern Nigerian Teaching Hospital.

BACKGROUND: Assessment of patterns of drug to detect performance problems and compliance with standards facilitates objective comparisons and impact evaluation. Children are at higher risk of consequences of irrational prescribing and antibiotic misuse. OBJECTIVE: The objective of the study was to evaluate the prescribing pattern and utilization of antibiotics for children using standard prescribing indicators and indices of rational drug prescribing. MATERIALS AND METHODS: This was a retrospective study of prescriptions for pediatric inpatients at a teaching hospital in Northern Nigeria. Information was obtained from eligible prescriptions received over 24-month period using a modified WHO prescribing indicator form. The WHO prescribing indicators and the Index of Rational Drug Prescribing (IRDP) were used to evaluate prescriptions. Data were analyzed and presented as proportions, means, tables, and charts, comparing with WHO standards and with findings of similar studies. RESULTS: There were 3908 eligible prescription orders, with a mean patient age of 3.1 (±2.7) years. With an average of 2.1 drugs per prescription, 66.8% were written with generic names, whereas a single antibiotic was included among 63% of prescriptions with antibiotics. Antibiotics and injections were contained in 49.5% and 67.7% of prescriptions, respectively. Medications were available in the Essential Medicines List in 95.5% of cases. The IRDP obtained is 2.99, against a standard of 5. Aminoglycosides, cephalosporins, and penicillins were the most common choices, whereas ampicillin/cloxacillin was the most common combination. CONCLUSION: Drug prescribing and antibiotic use were generally inappropriate compared with ideal standards. Continuous training/retraining on rational drug use, periodic monitoring, and use of treatment protocols in tertiary hospitals are recommended.

Evaluation of the cognitive effect of newborn resuscitation training on health-care workers in selected states in Northern Nigeria.

BACKGROUND: Neonatal deaths contribute significantly to slower progress in under-5 mortality reduction. Lack of sufficiently trained birth assistants partly contributes to early neonatal deaths. Resuscitation training equips frontline health-care workers (HCWs) with requisite knowledge and skills to prevent birth asphyxia. OBJECTIVE: The objective of this study was to evaluate the immediate impact of newborn resuscitation training on cognitive ability of HCWs. MATERIALS AND METHODS: This is a descriptive observational study using pre- and posttraining scores obtained by HCWs who were participants in 1-day training on emergency newborn resuscitation. The Newborn Resuscitation Manual of the UK Resuscitation Council (2006) was used to train HCWs. The course included lectures, skill and scenario demonstrations using mannequins, and basic resuscitation equipment. Cognitive knowledge was evaluated using a pre- and post-training questionnaire. Participants' scores were collated, analyzed, and results were presented as tables, charts, and descriptive statistics with P < 0.05 considered statistically significant. RESULTS: A total of 293 HCWs completed the course (81 doctors and 212 nurse/midwives), with variable improvements of mean posttraining marks over the pretraining scores. Resident doctors obtained significantly higher mean pre- and post-training marks with lower mean difference than senior doctors and medical officers. The junior nurses obtained significantly higher mean pretraining scores compared to the senior nursing cadre, while the intermediate nursing cadre obtained significantly higher mean posttraining scores compared to senior nurses. CONCLUSION: Resuscitation training improved the knowledge of HCWs. Further evaluation could ascertain impacts on knowledge/skills' retention and neonatal survival. Preservice training and continuing education for frontline HCWs who conduct deliveries are recommended.