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Assessment of rational antibiotic use among children being treated in primary care facilities in Punjab, Pakistan: findings and implications

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Abstract

Background

Antimicrobial resistance (AMR) is prevalent among south Asian countries including Pakistan mainly due to excessive and inappropriate use of antibiotics including among children. Globally, the majority of the population especially in low- and middle-income countries (LMICs) visit ambulatory care facilities seeking care

Objectives

The objectives of the current study were to evaluate the appropriateness of antibiotics prescribed among children below the age of 12 years in six ambulatory care health facilities against the WHO AWaRe book, 2022. The findings providing a basis for future initiatives.

Methods

A cross-sectional study was conducted among children below the age of 12 years in six ambulatory care health facilities among two districts of Punjab, over a period of three months (January–March 2023).

Results

Out of total of 399 children included in the study, 58.4% were male in the age group > 1 to 5 years (41.6%). The most common illnesses diagnosed were sinusitis (39.8%) followed by bronchitis (20.3%), and community-acquired pneumonia (15.8%). All the study participants were prescribed at least one antibiotic where only 35.8% (n = 143) of the prescribed antibiotics were deemed appropriate according to the indication. Out of 143 designated appropriate, 134 were appropriate according to the duration of prescribed antibiotics, 137 were appropriate according to the frequency of prescribed antibiotics and 139 were appropriate as per the route of administration. Inappropriate antibiotic therapy was more prevalent in basic health units than rural health centers (p = 0.004), and was higher in older children. Overall, 343 (83.3%) of the antibiotics prescribed were from ‘Access’ category followed by 69 (16.7%) from the ‘Watch’ category.

Conclusion

Our study concluded a high proportion of inappropriate antibiotic use in ambulatory care facilities. Consequently, urgent measures are needed to improve future prescribing and curb AMR.

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Authors and Affiliations

  1. Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia

    Zia Ul Mustafa, Amer Hayat Khan & Sabariah Noor Harun

  2. Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, 57400, Pakistan

    Zia Ul Mustafa

  3. Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Jail Road, Lahore, 54000, Pakistan

    Muhammad Salman

  4. Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, 0208, South Africa

    Johanna C. Meyer & Brian Godman

  5. South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, 0208, South Africa

    Johanna C. Meyer

  6. Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, G4 0RE, UK

    Brian Godman

Authors
  1. Zia Ul Mustafa
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  2. Amer Hayat Khan
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  3. Muhammad Salman
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  4. Sabariah Noor Harun
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  5. Johanna C. Meyer
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  6. Brian Godman
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Corresponding author

Correspondence to Zia Ul Mustafa.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflicts of interest

Zia Ul Mustafa, Amer Hayat Khan, Muhammad Salman, Sabariah Noor Harun1, Johanna C. Meyer, and Brian Godman have no conflicts of interest that are directly relevant to the content of this article.

Availability of data

All the relevant data from this project are available from the corresponding author upon appropriate request.

Ethics approval

Ethical approval of the current study was obtained from the Research Ethics Committee, Discipline of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore (REC/DPP/FOP/62).

Consent to participate

The parents/guardians of the children provided written informed consent for their enrollment in our study.

Consent for publication

Not applicable.

Code availability

Not applicable.

Authors contribution

All authors contributed equally to this project. All authors read and approved the final version.

Supplementary Information

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Supplementary file1 (PDF 290 KB)

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Ul Mustafa, Z., Khan, A.H., Salman, M. et al. Assessment of rational antibiotic use among children being treated in primary care facilities in Punjab, Pakistan: findings and implications. Drugs Ther Perspect 40, 160–171 (2024). https://doi.org/10.1007/s40267-024-01059-8

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  • DOI: https://doi.org/10.1007/s40267-024-01059-8

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