Antimicrobial use in children under five years with acute diarrhea in Amnatcharoen Hospital

Abstract

Background: Acute diarrhea is the major problem of children’s illness and death around the world. Treatment with empirical antibiotics is recommended for dysenteric or invasive bacterial diarrhea, overuse is common in clinical practice worldwide. Recent information on the use of antibiotics in Thai children with acute diarrhea is lacking.
Objective: To survey the appropriate use of empirical antibiotics in children with acute diarrhea in Amnatcharoen Hospital, evaluate the association between their use and clinical features, and to survey types of antibiotics, stool cultures and sensitivity to antibiotics.
Methods: Inpatient medical records of children aged 1 month to 5 years with acute diarrhea seen at Amnatcharoen Hospital during March to August 2010 were reviewed. Appropriate use of empirical antibiotics was defined as: use of an antibiotic in a child with a history of bloody-mucous diarrhea, who was suspected to be cholera, who had fecal white blood cell count of >10 cells/HPF, or no prescription of antibiotics in non-bloody diarrhea.
Results: There were 87 patient encounters, 80% of which were children under 2 years of age. There were 69% of cases prescribed antibiotics, despite 17.2% were bloody-mucous diarrhea. Of the 73 diarrheal episodes in which stool samples were cultured, 12 stool specimens were positive, four with Salmonella gr. B, two with Salmonella gr. c and each one with Salmonella gr. E, Shigella gr. D, v.cholerae non 01 /non 0139, E. coli, Edwardsiella tarda, Plesiomonas shigelloides. Antibiotics had been used appropriately in 48.3% of cases. Of the 51.7% of cases indentified as inappropriate use, 100% involved unnecessary antibiotic prescriptions in non-indicated cases. Ceftriaxone was the most commonly prescribed drug (60%), followed by cotrimoxazole (26.7%). Multivariate analysis showed that no associations between antimicrobial use and clinical features of diarrhea.
Conclusion: Overuse of antibiotics in the treatment of acute diarrhea in children is common. We should continue providing effective interventions aimed at improving physicians’ knowledge of diarrhea treatment. Similar efforts should be directed toward improving caretakers’ knowledge about home care for childhood diarrhea and encouraging use of oral rehydration solution (ORS). Hopefully, such activities will help reduce the inappropriate use of antimicrobial agents in treating diarrheal disease.