Evaluation of Antimicrobial Use and Adverse Drug Reactions in the Children Admitted to Paediatric Intensive Care Unit of Tertiary Care Hospital of Eastern India: A Prospective Observational Study
DOI:
https://doi.org/10.21276/8pp6d561Keywords:
Antimicrobial use, Paediatric Intensive Care Unit, Adverse drug reactions, Antibiotic prescription, Prospective observational studyAbstract
Background: Inappropriate antimicrobial use is a matter of increasing concern but suitable antibiotics prescribing practice means using effective, safe, and affordable antibiotics for precise duration. The present study was evaluated to know the use of antibiotics in relation to diagnosis and adverse drug reactions (ADRs) in the pediatric intensive care unit (PICU) of a tertiary hospital of eastern India.
Methods: In present study, 200 children of either sex, up to 12 years age, who admitted in PICU, were studied within a period of 18 months. Baseline demographic and clinical features, hospital stay duration, antimicrobials received, dosing, indications, and details of ADRs were recorded. Every patient was followed up till discharge or death.
Results: Data of total 200 children of PICU admissions, majority were boys (65.0%) and from rural (73.0%) background. Median age was 21 months (interquartile range [IQR] 6-72 months). Approximately similar numbers hailed from nuclear and joint families. Mothers were illiterate in 27.0% and fathers in 24.0% cases. 20.50% children died and the rest were discharged. All studied children of about 100.0% received antibiotics and 96.5% received combination or multiple (two or more) antibiotics. ADRs of at least “possible” causality, were noted in 0.57% instances.
Conclusion: Use of multiple antimicrobials per prescription and heavy reliance on parenteral route merits further exploration. Antimicrobials are mostly used empirically in absence of policy. These findings will hopefully be useful in future for planning long-term and more extensive drug utilization studies in the hospital and in promotion of rational prescribing and drug use. Finally, the baseline data can serve in situation analysis for local antibiotic prescribing guidelines.
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References
Ding H, Yang Y, Chen Y, Wang Y, Fan S, et al. Antimicrobial usage in
paediatric intensive care units in China. Acta Paediatr. 2008;97:100-104.
Abbas Q, Ul Haq A, Kumar R, Ali SA, Hussain K, et al. Evaluation of
antibiotic use in Pediatric Intensive Care Unit of a developing country.
Indian J Crit Care Med. 2016;20(5):291-294.
Wati DK, Gustawan IW , Fatmawati NND, Tunas IK, Setiawan PA.
Antibiotic surveillance in the pediatric intensive care unit (PICU) at
Sanglah Hospital Denpasar in the Year of 2015-2017. The Open
Microbiology Journal. 2019;13:146-153.
National Nosocomial Infections Surveillance System. National
Nosocomial Infections Surveillance (NNIS) system report, data summary
from january 1992 through june 2004, issued October 2004. Am J Infect
Control. 2004;32(8):470-485.
Banerjee SN, Grohskopf LA, Sinkowitz-Cochran RL, Jarvis WR.
Incidence of pediatric and neonatal intensive care unit-acquired
infections. Infect Control Hosp Epidemiol. 2006;27(6): 561-570.
Joram N, de Saint Blanquat L, Stamm D, Launay E, Gras Le Guen C.
Healthcare associated infection prevention in pediatric intensive care
units: A review. Eur J Clin Microbiol Infect Dis. 2012;31:2481-2490.
Blinova E, Lau E, Bitnun A, Cox P, Schwartz S, et al. Point prevalence
survey of antimicrobial utilization in the cardiac and pediatric critical care
unit. Pediatr Crit Care Med. 2013;14:e280-288.
Ceyhan M, Yildirim I, Ecevit C, Aydogan A, Ornek A, et al. Inappropriate
antimicrobial use in Turkish pediatric hospitals: A multicenter point
prevalence survey. Int J Infect Dis. 2010;14:e55-61.
van Houten MA, Luinge K, Laseur M, Kimpen JL. Antibiotic utilisation for
hospitalised paediatric patients. Int J Antimicrob Agents. 1998;10:161-
Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H, et al. The
worldwide antibiotic resistance and prescribing in European children
(ARPEC) point prevalence survey: Developing hospital-quality indicators
of antibiotic prescribing for children. J Antimicrob Chemother.
;71:1106-1117.
World Health Statistics. Geneva: World Health Organization; 2013.
Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, et al. Antimicrobial
resistance in India: A review. J Natural Sci Biol Med. 2013;4:286-291.
James A, Prakasam A, Kannan S, Kumar S, Practice P. Antimicrobials
prescribing patterns in urban and rural hospitals: determinants and
proposed interventions. International Journal of Pharmaceutical
Sciences Review and Research. 2013;21:100-104.
Chatterjee S, Mandal A, Lyle L, Mukherjee S, Singh AK. Drug utilization
study in a neonatology unit of a tertiary care hospital in eastern India.
Pharmacoepidemiol Drug Safety. 2007;16:1141-1145.
Mukherjee M, Sen S, Era N, Biswas A, Datta A, Tripathi SK. Antibiotic
usage pattern among inpatients of a paediatric ward in a tertiary care
hospital in Eastern India. International Journal of Research in Medical
Sciences. 2015;3:3681-3686.
Sahoo B, Patnaik S, Mishra R, Jain MK. Morbidity pattern and outcome
of children admitted to a paediatric intensive care unit of eastern India.
Int J Contemp Pedr. 2017;4:486-489.
Baidya S, Hazra A, Datta S, Das AK. Study of antimicrobial use in
children admitted to pediatric medicine ward of a tertiary care hospital.
Indian J Pharmacol. 2017;49:10-15.
Manjhi M, Das S, Pal M, Saha I, Srinath Reddy A. Incidence, risk factors,
clinicomicrobiological profile, change in ventilator settings needed and
outcome of 135 ventilator associated pneumonia cases in pediatric
intensive care unit (PICU) of a tertiary care centre in eastern India. J Pedr
Neonatal Individualized Med. 2018;7:e070122.
Narkhede V, Sinha U, Bhardwaj SD, Pitale S. Morbidity profile in under
five children in urban slum area of Nagpur. Natl J Community Med.
;3(3):442-446.
Sharma D, Reeta K, Badyal DK, Garg SK, Bhargava VK. Antimicrobial
prescribing pattern in an Indian tertiary hospital. Indian J Physiol
Pharmacol. 1998;42:533-537.
Rauniar GP, Naga Rani MA, Das BP. Prescribing pattern of antimicrobial
agents in paediatric in-patients. J Nepalgunj Med Coll. 2000;3:34-37.
Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, et al. A
prospective antibacterial utilization study in pediatric intensive care unit
of a tertiary referral center. Indian J Crit Care Med 2018;22:422-426.
Dutta S, Bhattacharjee A, Meena Devi N. Prescription pattern of
antibiotics in paediatric inpatients at a tertiary care hospital in north east
India. Int J Basic Clin Pharmacol. 2017; 6:2384-2388.
Reichler MR, Allphin AA, Breiman RF, Screiber JR, Amold JE, et al. The
spread of multiply resistant Streptococcus pneumoniae at a day care
center in Ohio. J Infect Dis. 1992; 166:1346-1353.
Kanish R, Gupta K, Juneja S, Bains HS, Kaushal S. Prescribing pattern
of antibiotics in the department of pediatrics in a tertiary care medical
college hospital in Northern India. Asian J Med Sci. 2014;5:57-61.
Sodhi J, Satpathy S, Sharma DC, Lodha R, Kapil A, et al. Healthcare
associated infections in paediatric intensive care unit of a tertiary care
hospital in India: Hospital stay & extra costs. Ind J Med Res.
;143:502-506.
Pharmacovigilance Programme of India. Suspected Adverse drug
Reaction Reporting Form. Available from: http://www.ipc.gov.in/
PvPI/ADRReportingForm.pdf. Accessed Oct 25, 2018.
Woldu MA, Suleman S, Gidi NW, Berhane H. Retrospective study of the
pattern of antibiotic use in Hawassa University Referral Hospital pediatric
ward, Southern Ethiopia. Journal of Applied Pharmaceutical Science.
;3(02):093-098.
Koopmansa LR, Finlaysonc A, Whitelawd A, Decloedtf EH, Dramowskic
A. Paediatric antimicrobial use at a South African hospital. Int J Infect
Dis. 2018;74:16-23.
Sharma M, Damlin A, Pathak A, Lundborg CS. Antibiotic prescribing
among pediatric inpatients with potential infections in two private sector
hospitals in central India. PLoS ONE. 2015;10(11):e0142317.
Prajapati V, Bhatt JD. Study of prescribing pattern of antimicrobial agents
in the pediatric wards at tertiary teaching care hospital, Gujarat. Indian J
Pharm Sci Res. 2012;3:2348-2355.
Chiotos K, Gerber JS, Himebauch AS. How can we optimize antibiotic
use in the pediatric intensive care unit. Pediatr Crit Care Med.
;18:903-904
Sharma D, Reeta K, Badyal DK, Garg SK, Bhargava VK. Antimicrobial
prescribing pattern in an Indian tertiary hospital. Indian J Physiol
Pharmacol. 1998;42:533-537.
Deshmukh V, Khadke V, Patil A, Lohar P. Study of prescribing pattern of
antimicrobial agents in indoor patients of a tertiary care hospital. Int J
Basic Clin Pharmacol. 2013;2:281-285.
Sivagnanam G, Thirumalaikolundusubramanian P, Mohanasundaram J,
Raaj AA, Namasivayam K, et al. A survey on current attitude of practicing
physicians upon usage of antimicrobial agents in southern part of India
.Medscape General Med. 2004;6:1.
Austin JD, Kristinsson KG, Anderson RM. The relationship between the
volume of antimicrobial consumption in human communities and the
frequency of resistance. Proc Natl Acad Sci USA. 1999;96:1152-1156.
Beg MA, Bawa S, Dutta S, Anjoom M, Vishal S. Study of antimicrobial
prescribing pattern in a tertiary care teaching hospital at Dehra Dun,
Uttarakhand, India - A tool to teach clinical pharmacology to MBBS
students. Int J Basic Clin Pharmacol. 2016;5:2444.
Tafelski S, Gratopp A, Richter F, Kramer S, Spies C, et al. Observational
clinical study on organ dysfunction associated with dosing of antibiotics
in a Pediatric Intensive Care Unit. Minerva Pediatr. 2018;70:331-339.
Palikhe N. Prescribing pattern of antibiotics in pediatric hospital of
Kathmandu Valley. J Nepal Health Council. 2004;2:31-36.
Cies JJ, Moore WS 2nd, Enache A, Chopra A. β-lactam therapeutic drug
management in the PICU. Crit Care Med. 2018;46:272-279.
National treatment guidelines for antimicrobial use in infectious diseases.
Version 1.0. New Delhi: National Centre for Disease Control, Directorate
General of Health Services, Ministry of Health & Family Welfare;
Government of India; 2016.
Bradley JS, Barnett ED, Cantey JB, eds. 2018 Nelson's pediatric
antimicrobial therapy, 24th ed. Washington DC: American Academy of
Pediatrics; 2018.
Khilnani P, ed. IAP textbook of Pediatric ICU protocols. 2nd ed. New
Delhi: Jaypee Brothers Medical Publishers; 2013.
National list of Essential Medicines 2015. New Delhi: Ministry of Health
& Family Welfare, Government of India.
Available from: http://cdsco.nic.in/WriteReadData/ NLEM2015/NLEM,%202015.pdf. Accessed on October 25, 2018.
Aagaard L, Hansen EH. Adverse drug reactions reported for systemic
antibacterials in Danish children over a decade. Br J Clin Pharmacol.
;70:765-768.
WHO (World Health Organization). Global action plan on antimicrobial
resistance. Geneva: World Health Organization; 2015.
Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL,
et al. A national point-prevalence survey of pediatric intensive care unitacquired infections in the United States. J Pediatr. 2002;140:432-438.
Mathew JL. Pneumococcal vaccination in developing countries: Where
does science end and commerce begin? Vaccine. 2009;27:4247-4251.
Impicciatore P, Choonara I, Clarkson A, Provasi D, Pandolfini C, et al.
Incidence of adverse drug reactions in paediatric in/out-patients: A
systematic review and meta-analysis of prospective studies. Br J Clin
Pharmacol. 2001;52:77-83.
Bavdekar SB, Karande S. National pharmacovigilance program. Indian
Pediatri. 2006;43: 27-32.
Priyadharsini R, Surendiran A, Adithan C, Sreenivasan S, Sahoo FK. A
study of adverse drug reactions in pediatric patients. J Pharmacol
Pharmacother. 2011;2:277-280.
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