The usage of antibiotics in paediatric patients while admitted to the intensive care unit at a public tertiary hospital
Date
2018
Authors
Sinyela, Nkhumiseni
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Abstract
Background: The overuse and misuse of antibiotics decreases their effectiveness and results in increasing bacterial resistance which is considered an international public health crisis. Antibiotics are one of the most commonly used groups of medicines in peadiatric patients however there are limited data available on the usage of antibiotics in paediatrics globally but especially in South Africa. The aim of this study was to conduct a retrospective review of antibiotics used in paediatric patients in intensive care.
Method: This study reviewed antibiotic therapy from patient charts in the Intensive Care Unit at Charlotte Maxeke Johannesburg Academic hospital. The review was done from 15 January 2016 to 15 February 2016 and 15 January 2017 to 15 February 2017.
Results: There were 40 files reviewed for 2016 and 55 files for 2017. Most patients (2016: 78% and 2017: 60%) were neonates aged between 0 -3 months. There were 15 antibiotics prescribed in 2016 and 2017 that differed between the two study periods. The most frequently prescribed antibiotics in 2016 were: vancomycin (19%), imipenem (18%), ampicillin (11%) and gentamycin (11%). In comparison in 2017, the most frequently prescribed antibiotics were meropenem (21.7%) vancomycin (20.8%) and co-amoxiclav (11.7%). In both periods majority of patients received two antibiotics as therapy during their ICU stay, 47.5% in 2016 and 40% in 2017. The average numbers of days in ICU were 5 days in 2016 and 4 days in 2017. Diagnosis classifications were similar between the two study periods. Cultures (blood) were ordered in 73% (2016) compared to 75% (2017). C-reactive protein samples were taken from 85% of patients in 2016 and 82% in 2017. In 2017, there were 46.2% (n=36) of doses with a hang time less than 60 minutes and 32.5% (n=26) in 2016.
Conclusion: This study showed that most antibiotics were prescribed empirically with imipenem and vancomycin the most used combination antibiotic therapy in 2016, meropenem and vancomycin in 2017. Majority of patients received two antibiotic therapies during their ICU stay.
CRP and cultures (blood) were frequently ordered and hang time mostly documented. Prescription of antibiotics was mostly compliant with the unit antibiotic prescription guidelines.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment for the degree of Masters of Science in Medicines: Pharmaceutical Affairs.
June 2018.