ASSESSMENT OF ANTIBIOTIC UTILIZATION PATTERN IN PAEDIATRIC HOSPITAL IN NIGERIA
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ABSTRACT
The inappropriate use of antibiotics in children predisposes them to the adverse effects of these drugs. So it is important to carry out drug use study in children in order optimize antibiotic use. The aim of this study was to assess the utilization pattern of antibiotics in Hasiya Bayero Paediatric Hospital, Kano state, Nigeria. Prescriptions issued to outpatients were collected prospectively and used to assess the World Health Organization (WHO) core drug use indicators based on WHO methodology. Educational intervention was provided to management, non-professional health care workers and parents/caregivers. The average number of drugs per prescription for the non-professional health care workers was 2.4, but this reduced to 2.1 after intervention. The percentage encounter with antibiotics was high (95%) for the non-professional health care workers before intervention, but this improved to 65% after intervention. About 44.2% of antibiotics were prescribed in generic name by the non-professional health care workers before intervention, but this value increased to 54.3% after intervention. The average consultation time for the non-professional health care workers was 8.4 minutes preintervention, which increased to 9.8 minutes post-intervention. The average dispensing time for the non-professional health care workers was 6.0 minutes and 4.5 minutes before and after intervention respectively. About 58.9% of patients attended by the nonprofessional health care workers were able to recall dosage schedule correctly before intervention, but this markedly improved to 80.4% after intervention. Copies of the EML were not sighted with the non-professional health care workers until after intervention. The average numbers of days that key antibiotics were out of stock decreased from 5 days to 3 days. Drug utilization 90% (DU 90%) analysis showed that cefixime was the most prescribed and utilized antibiotic by the non-professional health care workers. Amoxicillin/clavulanic acid was the most prescribed and utilized antibiotic by the viii professional health care workers. ABC (Always, Better, Control) analysis revealed that class A which consists of 6 antibiotics accounted for 74.75% of total antibiotic expenditure, class B consists of 6 antibiotics which accounted for 20.21% of antibiotic expenditure, while class C which had the most number of antibiotics (13) accounted for only 5.04% of antibiotic expenditure. VED (Vital, Essential, and Desirable) analysis revealed that group V consists of 7 antibiotics which accounted for 28.97% of expenditure; group E which consists of 10 antibiotics accounted for 28.97% of expenditure; while group D which consists of 8 antibiotics accounted for the highest antibiotic expenditure (50.91%). Inappropriate antibiotic use and high expenditure on less essential antibiotics may be related to lack of professional health care personnel and noncompliance to the basic principles of prescribing and dispensing. Provision of continuous education, establishment of drug and therapeutic committee and employment of more professional health care personnel can help ameliorate the set back.
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