Antibiotic Surveillance in Pediatric Intensive Care Unit of a Secondary Referral Healthcare Setting in South India

DOI:

https://doi.org/10.37285/ijpsn.2022.15.3.6

Authors

  • Mohanraj Rathinavelu Mudaliar Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) Autonomous, Ananthapuramu, Andhra Pradesh, India - 515721
  • Kummiti Veenasri PharmD Resident Intern,Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) Autonomous, Ananthapuramu, Andhra Pradesh, India - 515721.esh, India - 515721.
  • Gollapinni Divya Mallika PharmD Resident Intern,Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) Autonomous, Ananthapuramu, Andhra Pradesh, India - 515721.
  • Bodepadu Harikrishna PharmD Resident Intern, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) Autonomous, Ananthapuramu, Andhra Pradesh, India - 515721.
  • Myla Phebe Salomi PharmD Resident Intern, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) Autonomous, Ananthapuramu, Andhra Pradesh, India - 515721.
  • Dasaratha Ramaiah Consultant Pediatrician and Head, Department of Pediatrics, Rural Development Trust (RDT) Hospital, Bathalapalli, Ananthapuramu, Andhra Pradesh, India - 515661.
  • Dipak Dnyandeo Bharambe Assistant Manager Clinical Pharmacy, P D Hinduja Hospital and Medical Research Center, Mahim, Mumbai, India – 400016

Abstract

Background: Due to their maturing immune system and close proximity to one another, children are more liable to acquire and transmit infections than adults. Despite frequent antibiotic use in children, the primary focus of antibiotic drug utilization research to date has been the adult population. 

Objective: This study aims to evaluate the antibiotic utilization in a 5 bedded pediatric intensive care unit of a secondary referral hospital in south India. 

Material and methods: The cross-sectional observational study approved by the institutional ethics committee and institutional review board of six months duration was performed on patients of both genders admitted to the PICU of age 1 month to 18 years, with at least one antibiotic administration. 

Results: In a total of 84 PICU admissions, 96.43% were treated empirically. A total of 583 medications were prescribed, out of which 28.3% were antibiotics. In our study, amoxiclav, ceftriaxone and linezolid were observed to have a normal PDD: DDD ratio within limits. 95.24% was the survivor rate during the study.

Conclusion: The outcome of PICU antibiotic surveillance was found rational in relation to a 95.24% survival rate, but WHO DUS metrics calculation of PDD: DDD ratio forecast there is more under-utilization, as dose calculation in paediatrics is weight-based. In this regard, extensive research in exploring the new modalities like point prevalence survey, proportions of days covered, days of therapy; and antibiotic acquaintance by limiting wasted drug weight in pediatric patients is highly recommended to ensure optimized and rational antibiotic use.  

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Keywords:

Antibiotics, Drug utilization, Pediatric intensive care unit, Prescribing pattern

Downloads

Published

2022-06-30

How to Cite

1.
Mudaliar MR, Kummiti Veenasri, Gollapinni Divya Mallika, Bodepadu Harikrishna, Myla Phebe Salomi, Dasaratha Ramaiah, et al. Antibiotic Surveillance in Pediatric Intensive Care Unit of a Secondary Referral Healthcare Setting in South India. Scopus Indexed [Internet]. 2022 Jun. 30 [cited 2024 Nov. 19];15(3). Available from: https://ijpsnonline.com/index.php/ijpsn/article/view/2481

Issue

Section

Research Articles

References

Abbas Q, Ul Haq A, Kumar R, Ali SA, Hussain K, Shakoor S, et al (2016). Evaluation of antibiotic use in pediatric intensive care unit of a developing country. Indian J Crit Care Med 20:291-4.

Abhulimhen-Iyoha BI, Pooboni SK, Vuppali NKK (2014). Morbidity pattern and outcome of patients admitted into a pediatric ıntensive care unit in India. Indian Journal of Clinical Medicine 5:1-5.

Alexander J, Slater A, Woosley J (2014). Report of the Australian and New Zealand Paediatric Intensive Care Registry 2012. Brisbane: Australian and New Zealand Intensive Care Society.

Amadeo B, Zarb P, Muller A, et al (2010). European surveillance of antibiotic consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries. J Antimicrob Chemother 65:2247-52.

Bamel VV and Shahani SR (2018). Study of antibiotic prescription pattern in PICU of a tertiary care hospital. Int J Basic Clin Pharmacol 7:2319-2324.

Bellad R, Rao S, Patil VD, Mahantshetti NS (2009). Outcome of intensive care unit patients using pediatric risk of mortality (PRISM) score. Indian Pediatr 46:1091-92.

Blix HS, Engeland A, Litleskare I, Ronning M (2007). Age- and gender-specific antibacterial prescribing in Norway. Journal of Antimicrobial Chemotherapy 59:971-6.

Bradely JS (2007). Commentary: Antibiotic stewardship in paediatrics: a necessity. Pediatr Infect Dis J 26:538-539.

Briassoulis G, Natsi L, Tsorva A, Hatzis T (2004). Prior antimicrobial therapy in the hospital and other predisposing factors influencing the usage of antibiotics in a pediatric critical care unit. Ann Clin Microbiol Antimicrob 3:4.

Choi KMS, Ng DKK, Wong SF, Kwok KL, Chow PY, Chan CH et al (2005). Assessment of the pediatric index of mortality (PIM) and the pediatric risk of mortality (PRISM) III score for prediction of mortality in a paediatric intensive care unit in Hong Kong. Hong Kong Med J 11:97-103.

Clavenna A, Bonati M (2011). Differences in antibiotic prescribing in paediatric outpatients. Archives of Disease in Childhood 96:590-5.

Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G. et al (2005). Interventions to improve antibiotic prescribing practises for hospital inpatients. Cochrane Database Syst Rev 19:CD003543.

De Hoog ML, Venekamp RP, van der Ent CK, Schilder A, Sanders EA, Damoiseaux RA, et al (2014). Impact of early day care on healthcare resource use related to upper respiratory tract infections during childhood: prospective WHISTLER cohort study. BMC Medicine 12:107.

Dimri S, Tiwari P, Basu S, Parmar VR (2009). Drug use pattern in children at a teaching hospital. Indian Pediatr 46:165-7.

Ding H, Yang Y, Wei J, Fan S, Yu S, Yao K, et al (2008). Influencing the use of antibiotics in a Chinese pediatric Intensive Care Unit. Pharm World Sci 30:787-93.

Eulmesekian PG, Pérez A, Minces PG, Ferrero H (2007). Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit of Argentina. PediatrCrit Care Med 8:54-7.

Fischer JE, Ramser M, Fanconi S (2000). Use of antibiotics in pediatric intensive care and potential savings. Intensive Care Med 26:959-66.

Gemke RJ, Bonsel GJ (1995). Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group. Crit Care Med 23:238-45.

Grohskopf LA, Huskins WC, Sinkowitz-Cochran RL, Levine GL, Goldmann DA, Jarvis WR, et al (2005). Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 24:766-73.

Hoque M S, Masud M A H, Uddin A N (2012). Admission pattern and outcome in a paediatric intensive care unit of a tertiary care paediatric hospital in Bangladesh. DS (Child) H J 28:14-19.

Ibinabo Ibiebele, Charles S. Algert, Jennifer R. Bowen, and Christine L. Roberts(2018). Pediatric admissions that include intensive care: a population-based study. BMC Health Services Research 18:264.

Jyothi AK, Ankireddy K (2019). A study on clinical profile and outcome of patients in PICU (paediatric intensive care unit) at tertiary care unit. Int J Contemp Pediatr 6:757-60.

Kanish R, Gupta K, Juneja S, Bains HS, Kaushal S (2014). Prescribing pattern of antibiotics in the department of pediatrics in a tertiary care medical college hospital in Northern India. Asian J Med Sci 5:69-72.

Keogh C, Motterlini N, Reulbach U, Bennett K, Fahey T (2012). Antibiotic prescribing trends in a paediatric sub-population in Ireland. Pharmacoepidemiology and Drug Safety 21:945-52.

Khilnani P (2002). Consensus guidelines for pediatric intensive care units in India. Indian Pediatr 39:43-50.

Kumari A, Agarwal SC, and Goyal P (2019). Pattern of drug prescription in the pediatric intensive care unit of a tertiary care hospital with emphasis on antimicrobial utilization. Journal of Pediatric Critical Care 6:29-34.

Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, Thatte UM (2018). A prospective antibacterial utilization study in pediatric ıntensive care unit of a tertiary referral center. Indian J Crit Care Med 22:422-426.

Muller A, Monnet DL, Talon D, Hénon T, Bertrand X (2006). Discrepancies between prescribed daily doses and WHO defined daily doses of antibacterials at a university hospital. Br J Clin Pharmacol 61:585-591.

Nsimba SE (2006). Assessing prescribing and patient care indicators for children under five years old with malaria and other disease conditions in public primary health care facilities. Southeast Asian J Trop Med Public Health 37:206–14.

Pandiamunian J, Rajesharan A, Salwe KJ, Kolasani BP (2017). Int J Pharm Bio Sci 8:391-5.

Spyridis N, Sharland M (2008). The European Union Antibiotic Awareness Day: the paediatric perspective. Archives of Disease in Childhood 93:909-10.

Thiruthopu NS, Mateti UV, Bairi R, Sivva D, Martha S (2014). Drug utilization pattern in south Indian pediatric population: A prospective study. Perspect Clin Res 5:178-83.

Toltzis P, Rosolowski B, Salvator A (2001). Etiology of fever and opportunities for reduction of antibiotic use in a pediatric Intensive Care Unit. Infect Control Hosp Epidemiol 22:499-504.

Turner, David A; and Cheifetz, Ira M (2011). Antibiotics in the pediatric intensive care unit: Have we finally figured out that less is more?* Pediatric Critical Care Medicine 12:355-356.

van Houten MA, Luinge K, Laseur M, Kimpen JL (1998). Antibiotic utilisation for hospitalised paediatric patients. Int J Antimicrob Agents 10:161-4.

Vather A; Mc Kerrow NH; Morgan ME (2018). Factors underlying the changing of antibiotics in a paediatric intensive care unit in Pietermaritzburg, KwaZulu-Natal. South African Journal of Child Health 12:143-148.

Venkateswaramurthy N, Murali R, Sampath Kumar R (2013). The study of drug utilization pattern in pediatric patients. Int J Pharm PharmSci 5:140–4.

Wati DK, Gustawan IW, Fatmawati NND, Tunas IK, Setiawan PA (2019). Antibiotic surveillance in thepediatric intensive care unit (PICU) at Sanglah hospital Denpasar in the Year of 2015-2017. OpenMicrobiol J 13:146-53.

WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology and WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services. (‎2003)‎. Introduction to drug utilization research. World Health Organization. https://apps.who.int/iris/handle/10665/42627.

ATC/DDD Index 2012. WHO Collaborating Centre for Drug Statistics Methodology Norwegian Institute of Public Health. 2012 [cited 2012 Sep 1]. Available from: http://www.whocc.no/atc_ ddd_index/