[Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital]. / Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad.

OBJECTIVE: Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. METHODS: A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. RESULTS: A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). CONCLUSIONS: Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

Effectiveness of a program to improve antibiotic use in children hospitalized in a children's tertiary care facility in Argentina.

INTRODUCTION: Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. OBJECTIVE: To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. MATERIAL AND METHODS: Prospective, longitudinal, before and after study with no control group. STUDY PERIOD: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). RESULTS: In the pre-intervention period,376 patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). CONCLUSION: The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.

Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital pediátrico de tercer nivel de atención en Argentina / Effectiveness of a program to improve antibiotic use in children hospitalized in a children's tertiary care facility in Argentina

Introducción. El uso inapropiado de antibióticos se relaciona con el incremento de los microorganismos resistentes, mayor morbimortalidad e impacto en la salud pública. Objetivo. Evaluar la efectividad de un programa para mejorar la adecuación del uso de los antimicrobianos en los pacientes internados en el Hospital Garrahan. Material y métodos. Estudio prospectivo, longitudinal, antes-después, sin grupo control. Período de estudio: del 1/7/2010 al30/6/2011. Se incluyeron pacientes con antibiótico parenteral. Se excluyeron los recién nacidos, quemados y aquellos con antibiótico como profilaxis. Se comparó el período previo y posterior a la implementación de talleres de discusión y monitoreo de indicaciones de antibióticos y la difusión de guías de tratamiento. Se realizó análisis univariado y estudio de regresión logística múltiple (STATA 8.0). Resultados. En el período preintervención, se incluyeron 376 pacientes; el 35,6% recibió tratamiento inadecuado. En el análisis de regresión múltiple, las variables finales de uso inadecuado fueron la infección respiratoria aguda baja (OR 3,80; IC 95% 1,35-3,26; p= 0,04), la fiebre sin foco en el paciente internado (OR 5,55; IC 95% 2,43-12,6; p < 0,01) y la neutropenia febril (OR 0,29; IC 95% 0,10-0,7; p < 0,01). Postintervención: se incluyeron 357 pacientes; 21,5% recibió tratamiento inapropiado. Se observó un descenso en la prescripción antibiótica inadecuada respecto al período preintervención (p < 0,01). En el análisis de regresión múltiple, las variables finales respecto al uso inadecuado fueron infección de piel y partes blandas (OR 0,33; IC 95% 0,13-0,93; p= 0,035) y neutropenia febril (OR 0,48; IC 95% 0,22-0,94; p= 0,04). Conclusión. El programa fue efectivo. Permitió mejorar las prácticas de prescripción de antibióticos en pacientes pediátricos hospitalizados.

Introduction. Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. Objective. To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. Material and Methods. Prospective, longitudinal, before and after study with no control group. Study period: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). Results. In the pre-interventionperiod,376patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). Conclusion. The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.

Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad / Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital

Objetivo. Describir el estado de la aplicación de la norma relacionada con la prohibición de la venta de antibióticos sin prescripción médica en farmacias de Bogotá, Colombia. Métodos. Estudio descriptivo transversal, en el cual se utilizó la técnica de simulación de compra en farmacias (droguerías) de Bogotá. La muestra de 263 farmacias se calculó con una precisión de 5% y un factor de corrección de 2% mediante estratificación (farmacias de cadena e independientes) y asignación aleatoria simple en cada estrato. Resultados. Del total de farmacias estudiadas, 80,3% no cumplen la norma que establece la venta de antibióticos con receta. En 20,1% de los casos, el expendedor indagó la edad del paciente o sus síntomas o ambos, con el fin de ofrecer otros medicamentos o para cambiar el antibiótico. En ninguna oportunidad se preguntó por antecedentes personales de alergia a los antibióticos. En los casos en los cuales hubo intención de venta del antibiótico, la presentación genérica fue la más comúnmente ofrecida (81,2%). Algunos expendedores de medicamentos hicieron recomendaciones inapropiadas. Las localidades con mayor incumplimiento de la norma coinciden con aquellas que tienen altas tasas de necesidades básicas insatisfechas. Conclusiones. A cinco años de adopción de la norma orientada a contrarrestar la venta libre de antibióticos, su cumplimiento es mínimo y la entrega no se realiza de acuerdo a los parámetros establecidos. El personal de farmacia no suministra la información requerida de acuerdo con sus competencias.

Objective. Describe the implementation status of a regulation prohibiting antibiotic sales without a medical prescription in pharmacies of Bogotá, Colombia. Methods. A cross-sectional descriptive study was conducted using the simulated purchase technique in Bogotá pharmacies (drugstores). The sample of 263 pharmacies was calculated by stratification (chain pharmacies and independent pharmacies) with 5% accuracy and a 2% correction factor. Simple randomization was assigned in each stratum. Results. Out of the total pharmacies studied, 80.3% did not comply with the regulation established for prescription sales of antibiotics. In 20.1% of the cases, the dispenser asked about the patient’s age, symptoms, or both age and symptoms in order to offer other drugs or change the antibiotic. There were no inquiries about a medical history of allergy to antibiotics. In cases in which there was the intention to sell antibiotics, the generic format was most commonly offered (81.2%). Some drug dispensers made inappropriate recommendations. The locations with the highest levels of noncompliance with the regulation were also those with high rates of unmet basic needs. Conclusions. Five years after passage of a regulation to halt the unrestricted sales of antibiotics, there is minimal compliance, and dispensing does not conform to the established parameters. Pharmacy personnel do not provide the required information according to their responsibilities.