BACKGROUND: There is a need to evaluate antibiotic use, duration of therapy and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. METHODS: We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy and appropriateness of antibiotic prescriptions by five main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions and neighbors or family members). RESULTS: Ninety percent of children received an antibiotic during follow-up time, and on average, by the end of follow-up a child had spent 4.3% of their first five years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%) and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics. CONCLUSION: Stewardship programs should target medical personnel for a primary care stewardship program even in a context where antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.
BACKGROUND: There is a need to evaluate antibiotic use, duration of therapy and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. METHODS: We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy and appropriateness of antibiotic prescriptions by five main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions and neighbors or family members). RESULTS: Ninety percent of children received an antibiotic during follow-up time, and on average, by the end of follow-up a child had spent 4.3% of their first five years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%) and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics. CONCLUSION: Stewardship programs should target medical personnel for a primary care stewardship program even in a context where antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.
Authors: Elizabeth T Rogawski McQuade; Stephanie A Brennhofer; Sarah E Elwood; Timothy L McMurry; Joseph A Lewnard; Estomih R Mduma; Sanjaya Shrestha; Najeeha Iqbal; Pascal O Bessong; Gagandeep Kang; Margaret Kosek; Aldo A M Lima; Tahmeed Ahmed; Jie Liu; Eric R Houpt; James A Platts-Mills Journal: Proc Natl Acad Sci U S A Date: 2022-08-29 Impact factor: 12.779