Rational Prescribing of Antibiotics in Children Under 5 Years with Upper Respiratory Tract Infections in Kintampo Municipal Hospital

Abstract

Background: Upper respiratory tract infections are the most frequently occurring illness of children due to their low immunity and are of high cost to society, being responsible for children absenteeism from school and parents from work. Despite their predominant viral aetiology and self-limiting nature, they continue to be treated with antibiotics. The inappropriate use of these antibiotics in children is accompanied by serious adverse effects. When antibiotics are indicated, there is the need to choose the appropriate effective agent and dose, frequency of intake, duration with the narrowest spectrum, fewest side effects and lowest cost. This study sought to find out how rationally, antibiotics are prescribed in children under five years with upper respiratory tract infections in Kintampo Municipal Hospital. Methods: A review of records was carried out using the medical records of children under five years who attended the out-patient department of Kintampo Municipal Hospital from 1st January, 2009 to 31st December, 2014 and were managed for upper respiratory tract infections. A total of 270 patients’ cards/folders were selected through systematic random sampling and information on age, sex, diagnosis and medication with dose, frequency and duration of therapy extracted. Five prescribers were also interviewed through structured questionnaires. The data were analyzed using Microsoft Excel 2013 and STATA SE Version 13 (College of Texas, USA) at 95% Confidence Interval and statistical significance set at p<0.05. Results: There were 270 prescriptions obtained from 140 (51.8%) male children and 130 (48.2%) female children. A total of 839 medicines were prescribed, made up of 237 antibiotics and other medicines such as antipyretics, antihistamines, nasal decongestants and cough mixtures. The prescribers interviewed were 3 males and 2 females. The mean number of medicines prescribed per patient encounter was 3.1.The percentage of patient encounters with antibiotics was 28.2% and with injections 0.4%. The percentage of medicines prescribed generically was 93.8% and from the Essential Medicines List 94.9%. The most diagnosed upper respiratory tract infections were common cold 142 of 270 (52.6%) and otitis media, a complication of URTI with high antibiotic use accounted for 69 (25.6%). The most prescribed antibiotic was amoxicillin 92 (38.8%) belonging to the penicillin class of antibiotics. The category of prescriptions with 5 to 6 medicines prescribed per patient encounter was significantly associated with rational prescribing [AOR 0.17 (95%, C.I; 0.03-0.87), p-value=0.033].The average consulting time was 12 minutes. Conclusion: There was good adherence to rational prescribing as most of the prescribing indicators fell within the WHO/INRUD standards. Out of five prescribing indicators, only the mean number of medicines prescribed per patient encounter was higher than the required WHO Standard. Common cold and otitis media are the common upper respiratory tract infections and related infections managed in the institution. The penicillins and cephalosporins are the most preferred antibiotics prescribed for the management of upper respiratory tract infections in children under five years.