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Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia

European Journal of Pediatrics volume 179, pages 743–748 (2020)Cite this article

Abstract

Inappropriate use of antibiotics in human and animal is one of the causes of antimicrobial resistance. This study evaluates the prevalence and predictors of antibiotic use among pediatric patients visiting the Emergency Department (ED) in Malaysia. A retrospective cross-sectional study was conducted in the ED of a tertiary hospital. Data of children aged 2 to 11 years who visited the ED from January–May 2015 were extracted from the patient’s assessment forms. A total of 549 children were included in the analysis (median age 5 years) of which 54.3% were boys. Upper respiratory tract infections (URTI) were the most common diagnosis. Antibiotic was prescribed in 43.5% of the children. Children who visited the ED during the weekend (OR, 1.65; 95% confidence interval (CI) 1.13–2.40, P = 0.009), those diagnosed with URTI (OR 3.81; 95% CI, 2.45–5.93, P < 0.001) and those with a longer duration of fever (OR, 1.31; 95% CI, 1.15–1.48, P < 0.001) were more likely to have an antibiotic prescription.

Conclusions: Antibiotic was prescribed in more than one-third of children who visited the ED and antibiotic use was associated with visits during the weekend, URTI, and duration of fever. Antimicrobial stewardship program is recommended in the pediatric ED to improve appropriate use of antibiotics.

What is Known:
•Use of antibiotic among children increases the risk of antibiotic resistance and adverse drug reactions.
•Patient-, clinical-, and prescriber-related factors are three important domain associated with antibiotic use in children.
What is New:
•Fever and upper respiratory tract infections account for majority of antibiotic prescriptions.
•The “weekend effect” influences the use of antibiotics in the ED while upper respiratory tract infection is the strongest predictor of antibiotic use among children visiting the ED.

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Abbreviations

ANSORP:

Asian Network for Surveillance of Resistant Pathogens

CI:

Confidence interval

ED:

Emergency Department

IQR:

Interquartile range

MO:

Medical officer

OR:

Odds ratio

SBI:

Serious bacterial infections

URTI:

Upper respiratory tract infections

US:

United States

References

  1. World Health Organization. Antimicrobial resistance: global report on surveillance. World Health Organization. 2014. http://apps.who.int/iris/bitstream/handle/10665/112642/?sequence=1. Accessed on 24, September 2018

  2. US Department of Health and Human Services. Antibiotic resistance threats in the United States. Centers for Disease Control and Prevention. 2013. https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed on 24 September, 2018

  3. European Centre for Disease Prevention and Control & European Medicines Agency. The Bacterial Challenge: Time to React-A Call to Narrow the Gap Between Multidrug-Resistant Bacteria in the EU and the Development of New Antibacterial Agents. ECDC/EMEA Joint Technical report. 2009. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf. Accessed on 25 September, 2018

  4. Song J-H, Jung S-I, Ko KS, Kim NY, Son JS, Chang H-H, Ki HK, Oh WS, Suh JY, Peck KR (2004) High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother 48(6):2101–2107

    CAS  Article  Google Scholar 

  5. Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D (2002) Trends of outpatient prescription drug utilization in US children. Pediatrics 2012:2011–2879

    Google Scholar 

  6. Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, Smith S, Crook DW, Mant D (2007) Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. Bmj 335(7617):429

    CAS  Article  Google Scholar 

  7. Horton DB, Scott FI, Haynes K, Putt ME, Rose CD, Lewis JD, Strom BL (2015; peds) Antibiotic exposure and juvenile idiopathic arthritis: a case–control study. Pediatrics:2015–0036

  8. Barata I, Brown KM, Fitzmaurice L, Griffin ES, Snow SK (2015) Best practices for improving flow and care of pediatric patients in the emergency department. Pediatrics 135(1):e273–e283

    Article  Google Scholar 

  9. Hersh AL, Shapiro DJ, Pavia AT, Shah SS (2011: p. peds) Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics:2011–1337

  10. Ab Rahman N, Teng CL, Sivasampu S (2016) Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis 16(1):208

    Article  Google Scholar 

  11. Kho BP, Ong CM, Tan FT, Wee CY (2013) Antibiotic prescribing for upper respiratory tract infections in Sarawak district hospitals. Med J Malaysia 68(2):136–140

    CAS  PubMed  Google Scholar 

  12. Harnden A, Perera R, Brueggemann AB, Mayon-White R, Crook D, Thomson A, Mant D (2007) Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study. Arch Dis Child

  13. Clarke E, Finn A (2010) Current approaches to the treatment of URTIs in children. Prescriber 21(23–24):40–48

    Article  Google Scholar 

  14. Gerber JS, Prasad PA, Localio AR, Fiks AG, Grundmeier RW, Bell LM, Wasserman RC, Rubin DM, Keren R, Zaoutis TE (2013: p. peds) Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics:2012–2500

  15. Elshout G, Kool M, Van der Wouden JC, Moll HA, Koes BW, Berger MY (2012) Antibiotic prescription in febrile children: a cohort study during out-of-hours primary care. J Am Board Fam Med 25(6):810–818

    Article  Google Scholar 

  16. Van De Voort E, Mintegui S, Gervaix A, Moll H, Oostenbrink R (2018) Antibiotic use in febrile children presenting to the emergency department: a systematic review. Front Pediatr 6:260

    Article  Google Scholar 

  17. Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, Keijzers G (2018 Nov 15) Appropriateness of antibiotic prescribing in the Emergency Department. J Antimicrob Chemother 74(2):515–520

    Article  Google Scholar 

  18. Goh AY, Chan TL, Abdel-Latiff ME (2003 Aug) Paediatric utilization of a general emergency department in a developing country. Acta Paediatr 92(8):965–969

    CAS  Article  Google Scholar 

  19. Sharma S, Bowman C, Alladin-Karan B, Singh N (2016) Antibiotic prescribing patterns in the pediatric emergency department at Georgetown Public Hospital Corporation: a retrospective chart review. BMC Infect Dis 16(1):170

    Article  Google Scholar 

  20. Zeng L, Hu D, Choonara I, Mu D, Zhang L, Li X, Zhang Z, Hu Z, Quan S (2017) A prospective study of the use of antibiotics in the Emergency Department of a Chinese University Hospital. Int J Pharm Pract 25(1):89–92

    Article  Google Scholar 

  21. Bishara J, Hershkovitz D, Paul M, Rotenberg Z, Pitlik S (2007) Appropriateness of antibiotic therapy on weekends versus weekdays. J Antimicrob Chemother 60(3):625–628

    CAS  Article  Google Scholar 

  22. Bauchner H, Pelton SI, Klein JO (1999) Parents, physicians, and antibiotic use. Pediatrics 103(2):395–401

    CAS  Article  Google Scholar 

  23. Horwood J, Cabral C, Hay AD, Ingram J (2016) Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study. Br J Gen Pract

  24. Yaeger JP, Temte JL, Hanrahan LP, Martinez-Donate P (2015) Roles of clinician, patient, and community characteristics in the management of pediatric upper respiratory tract infections. Ann Fam Med 13(6):529–536

    Article  Google Scholar 

  25. Nyquist A-C, Gonzales R, Steiner JF, Sande MA (1998) Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 279(11):875–877

    CAS  Article  Google Scholar 

  26. O’Brien K, Bellis TW, Kelson M, Hood K, Butler CC, Edwards A (2015) Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study. Br J Gen Pract 65(638):e585–e592

    Article  Google Scholar 

  27. Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC (2007) Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ 335(7627):982

    CAS  Article  Google Scholar 

  28. Hassali MA, Kamil TKT, Md Yusof FA, Alrasheedy AA, Yusoff ZM, Saleem F, Al-Tamimi SK, Wong ZY, Aljadhey H, Godman B (2015) General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications. Expert Rev Anti-Infect Ther 13(4):511–520

    CAS  PubMed  Google Scholar 

  29. Watson RL, Dowell SF, Jayaraman M, Keyserling H, Kolczak M, Schwartz B (1999) Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics 104(6):1251–1257

    CAS  Article  Google Scholar 

  30. Elshout G, van Ierland Y, Bohnen AM, de Wilde M, Oostenbrink R, Moll HA, Berger MY (2013) Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study. Br J Gen Pract 63(612):e437–e444

    Article  Google Scholar 

  31. Nijman RG, Vergouwe Y, Thompson M, Van Veen M, Van Meurs AHJ, Van Der Lei J, Steyerberg EW, Moll HA, Oostenbrink R (2013) Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. BMJ 346:f1706

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge the Director General of Health Malaysia for the permission to publish this report. We wish to thank the Director of Hospital Tengku Ampuan Afzan for the permission to conduct this study.

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Affiliations

  1. School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia

    Tham Daniel Wai Je & Balamurugan Tangiisuran

  2. National Poison Centre, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia

    Usman Abubakar & Balamurugan Tangiisuran

Authors
  1. Tham Daniel Wai Je
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  2. Usman Abubakar
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  3. Balamurugan Tangiisuran
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Contributions

Conceptualization: Daniel Tham Je Wai and Balamurugan Tangiisuran; Methodology: Daniel Tham Je Wai, Balamurugan Tangiisuran; Formal analysis and investigation: Daniel Tham Je Wai, Usman Abubakar, and Balamurugan Tangiisuran; Writing—original draft preparation: Daniel Tham Je Wai and Usman Abubakar; Writing—review and editing: Usman Abubakar and Balamurugan Tangiisuran; Resources: Daniel Tham Je Wai and Balamurugan Tangiisuran; Supervision: Balamurugan Tangiisuran. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Balamurugan Tangiisuran.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Medical Research and Ethics Committee, Ministry of Health Malaysia, reference number: 15-1648-27798) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Tham, D.W.J., Abubakar, U. & Tangiisuran, B. Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia. Eur J Pediatr 179, 743–748 (2020). https://doi.org/10.1007/s00431-019-03560-z

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Keywords

  • Antibiotic
  • Pediatric
  • Emergency Department
  • Upper respiratory tract infection