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Assessment of anti-infective medication adherence in pediatric outpatients

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A Correction to this article was published on 29 March 2021

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Abstract

The objective of this pilot study was to assess the overall adherence rate of the pediatric population to anti-infective drugs prescribed for acute infection at hospital discharge and to identify risk factors for non-adherence behavior. Pediatric patients discharged from a French university hospital with at least one oral drug prescription for acute infection were included for 3 months. Medication adherence and antibiotic knowledge were assessed through data collected by calling the parents. Overall adherence was assessed according to seven items: medication order filling, administered dose, time of intake, frequency of doses, medication omission, dose modification, and length of treatment. Seventy-five patients were included, and 63 interviews were exploited. The median age was 1.4 years, IQR = [0.7; 3.3]. Overall adherence to anti-infective agents concerned 34.9% of patients. The most frequently prescribed antibiotics were amoxicillin (29.3%), amoxicillin associated with clavulanic acid (25.3%), cotrimoxazole (18.7%), and cefixime (12.0%). A lack of parents’ anti-infective knowledge was associated with non-adherence to anti-infective drugs.

Conclusion: Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases. The misunderstanding of anti-infective treatment could be a risk factor for non-adherence. Implementation of preventive actions such as therapeutic education or pharmaceutical counseling at hospital discharge could improve adherence to anti-infective agents.

What Is Known:

• Non-adherence to anti-infective drugs involves the emergence and spread of antibiotic resistance.

• Very few studies have assessed medication adherence in acute infectious diseases in pediatrics after hospital discharge.

What Is New:

• Only 35% of children were overall adherent to anti-infective drugs in acute infectious disease after hospital discharge.

• Most patients (89%) had a good primary adherence but very few (40%) had good secondary adherence mainly due to dose omission and dose modification.

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Abbreviations

CNIL:

Commission nationale de l’informatique et des libertés

CPP:

Comité de protection des personnes

IQR:

Interquartile range

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Acknowledgments

We thank Mrs. Caroline Mangerel for the English correction and Dr. Thierry Chevallier for their methodological advice.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France

    Marion Warembourg, Nelly Lonca, Michèle Knight, Alexia Janes, Ian Soulairol & Géraldine Leguelinel-Blache

  2. Department of Pediatrics, Nimes University Hospital, University of Montpellier, Nimes, France

    Anne Filleron & Tu Anh Tran

  3. INSERM U 1183, Team 3, Immune Regulation and Microbiota, University of Montpellier, Montpellier, France

    Anne Filleron & Tu Anh Tran

  4. UMR 5253, MACS Team, ICGM, University of Montpellier, Montpellier, France

    Ian Soulairol

  5. Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES, EA 2415, University of Montpellier, Montpellier, France

    Géraldine Leguelinel-Blache

Authors
  1. Marion Warembourg
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  2. Nelly Lonca
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  5. Michèle Knight
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  8. Géraldine Leguelinel-Blache
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Contributions

MW: co-writing the study protocol; writing the case report form, including the patients, collecting and entering the data; performing statistical analysis and writing the article

NL: co-writing the case report form, checking the data entered, co-writing and correcting the article

AF: co-writing the study protocol, co-writing the case report form, referring to WM patients for inclusion, co-writing and correcting the article

TAT: co-writing the study protocol, referring to WM patients for inclusion, co-writing and correcting the article

MK: co-writing the case report form, correcting the article

AJ: co-writing the case report form, correcting the article

IS: co-writing the study protocol, correcting the article

GLB: writing the study protocol, co-writing the case report form, supervising and planning the study, verifying statistical analysis, co-writing and correcting the article

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Géraldine Leguelinel-Blache.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the French Data Protection Authority (French acronym CNIL), and a registration number was attributed by a Personal Protection and Ethics Committee (French acronym CPP) (no 2017-A03114-49).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Nicole Ritz

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The text “The adherent patients' rate to antibiotics taken at home ranged from 46.5 to 79.6% and was measured by an adult adherence test (Morisky Medication Adherence Scale named MMAS-4)" has been corrected to "The adherent patients' rate to antibiotics taken at home ranged from 46.5 to 79.6% and was measured by an adult adherence test named Morisky-Green test." [Bold emphasis indicates the error part]

Appendices

Appendix 1. Medication adherence questionnaire

➢ Has your child had any side effects during his or her anti-infective treatment? // Have you had any problems due to the treatment?

○ Yes

○ No

- Which kind was it?

- What did you do?

Summary of answers:

❑ None

❑ Medical consultation

❑ Emergency

❑ Hospitalization

❑ Early discontinuation of treatment

❑ Drug switching

❑ Remedial treatment

❑ Dose modification

➢ When did you pick up your medication at the pharmacy?

Did you have any problems to order medications?

➢ On what day and at what time did your child start his/her treatment?

➢ How did you administrate the anti-infective treatment? Can you describe the action?

With which device did you administer the medication (if it is an oral solution)?

How did you reconstitute the oral suspension?

➢ What dose did you give him/her?

➢ At what time(s) of the day should you give this (these) anti-infective drug(s)?

Summary answers if time was not respected:

❑ Patient asleep at the usual time

❑ Refusal of drug administration by a third party (nursery…)

❑ Medication not given at school

How many times a day did you give him/her?

➢ Can you tell me what day and at what time of day your child stopped treatment?

➢ Did he/she stop his/her treatment before the prescription expired?

○ Yes

○ No

If so, why?

Medical advice:

○ Yes

○ No

Summary of answers:

❑ Allergy

❑ Diagnosis overruled

❑ Difficulty in administration

❑ Insufficient amount of drug

❑ Intolerance

❑ Medication not given to the caregiver

❑ Misunderstanding of the prescription

❑ Unpleasant organoleptic characteristics

❑ Worsening of the infection

❑ Unknown

➢ Did he/she continue his/her treatment after the prescription expired?

○ Yes

○ No

If so, why?

Summary of answers:

❑ Forgetting or skipping dose during treatment

❑ Persistent infection

❑ Willingness to finish the vial

❑ Unknown

➢ Have you ever forgotten to give one or more doses of the anti-infective treatment?

If so, why?

Summary answers:

❑ High number of daily doses

❑ Lack of treatment information

❑ No reason

❑ Other priorities

➢ Have you ever voluntarily skipped one or more doses of the anti-infective treatment? Why?

Summary of answers:

❑ Adverse effects

❑ Insufficient amount of drug

❑ Inability to administer/sleeping patient

❑ Medication not given to the caregiver

❑ On medical advice

❑ Refusal of administration by a third party (nursery)

❑ School

❑ Unpleasant taste and palatability

➢ Did you have to change the dose of anti-infective medication(s) for any reason?

Why?

Summary of answers:

❑ Drug adverse effect

❑ Inappropriate pharmacological advice

❑ Insufficient amount of medication

❑ Overdose leading to a missing dose.

➢ How did you store the anti-infective medication?

➢ Do you consider the treatment to have been effective?

Appendix 2. Antibiotic knowledge quiz

1. What is the name of the anti-infective treatment(s) prescribed for your child?

2. Can you tell me why your child was prescribed this treatment?

3. What dose did your child receive?

4. At what time(s) of the day did your child have to take this (these) anti-infective drug(s)?

5. Do you know the main adverse effects that may occur during this treatment? List one or two.

6. Do you know what antibiotics are effective on?

a. Bacteria

b. Viruses

c. The both

7. Are antibiotics effective on the influenza virus?

a. Yes

b. No

8. If your child feels better before the end of the treatment prescription, what do you do?

9. Can you use the same antibiotic if the same symptoms appear later and there are still medications at home?

a. Yes

b. No

10. What should be done if you forget to give or take an antibiotic drug?

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Warembourg, M., Lonca, N., Filleron, A. et al. Assessment of anti-infective medication adherence in pediatric outpatients. Eur J Pediatr 179, 1343–1351 (2020). https://doi.org/10.1007/s00431-020-03605-8

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  • DOI: https://doi.org/10.1007/s00431-020-03605-8

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