Hospital Pharmacy - February 2018 - 44

737429
research-article2017

HPXXXX10.1177/0018578717737429Hospital PharmacyGirma et al

Article

Antimicrobial Utilization Pattern in
Pediatric Patients in Tertiary Care
Hospital, Eastern Ethiopia: The Need
for Antimicrobial Stewardship

Hospital Pharmacy
2018, Vol. 53(1) 44-54
© The Author(s) 2017
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https://doi.org/10.1177/0018578717737429
DOI: 10.1177/0018578717737429
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Samuel Girma1, Mekonnen Sisay1, Getnet Mengistu1,
Firehiwot Amare1, and Dumessa Edessa1

Abstract
Background: Antimicrobials are among the most frequently prescribed medications for pediatric patients. However,
inappropriate use of them can increase morbidity, mortality, healthcare costs, and largely antimicrobial resistance. This
study aims to assess the antimicrobial utilization pattern in the pediatric ward of Hiwot Fana Specialized University Hospital.
Methods: Retrospective cross-sectional study was conducted to assess the antimicrobial utilization. In this study, 403
pediatric medical records selected by systematic random sampling were reviewed. Data were collected using structured
data abstraction format. Results: Ceftriaxone (n = 176, 26.5%), gentamicin (n = 125, 18.82%), and ampicillin (n = 119,
17.9%) were the most frequently prescribed antimicrobials, whereas ampicillin and gentamicin combination took the largest
percentage share (n = 91, 43.3%). The most common reasons for which antimicrobials prescribed were severe pneumonia (n
= 93, 18.82%), severe acute malnutrition (n = 69, 13.97%), and meningitis (n = 67, 13.56%). On average, the highest number
of antimicrobials per card was observed in neonates. The percentage of antimicrobials administered by parenteral route
was found to be 84.33%. Less than half of antimicrobials (46.98%) were prescribed with dosage form. Besides, strength and
duration were recorded in 20.03% and 4.21% of antimicrobial agents, respectively. Conclusion: Generally, there was an
overuse of injectables despite the fact that oral formulations are safer alternatives. This result is too far from World Health
Organization (WHO) standard (13.4%-21.1%). The degree of polypharmacy of antimicrobials falls within the WHO cutoff
point (<2). There are no antibiogram tests conducted in the hospital. By and large, this study provides an impetus towards
the establishment of antimicrobial stewardship programs.
Keywords
antimicrobials, pediatrics, medical records, Hiwot Fana Specialized University Hospital

Introduction
Antimicrobials are the key drugs for the treatment and prevention of infectious diseases and are among the most
widely prescribed drugs in pediatric population.1 The inevitable consequence of the widespread use of these agents
leads to the emergence of antimicrobial-resistant pathogens,
urging an ever-increasing need for new drugs. The current
global increase in antimicrobial resistance (AMR) and,
simultaneously, the downward trend in the development of
new antimicrobials have serious public health and economic
implications. Therefore, rational and judicious selection of
these agents for the therapy of infectious diseases requires
clinical judgment and in-depth knowledge of microbiological and pharmacological factors.2-4
Antimicrobial agents have 3 general purposes: empirical
therapy, definitive therapy, and prophylactic therapy. When
used as empirical therapy, the antimicrobial agent should

cover all the likely pathogens because the infecting organism has not yet been defined. Either combination therapy
or, preferably, treatment with a single broad-spectrum agent
may be employed. However, once the infecting microorganism is identified, definitive antimicrobial therapy should
be instituted with a narrow-spectrum and safe agent to complete the course of treatment. Prescribing and consumption
pattern should be studied, and control mechanisms must be
in place to avoid drug resistance, treatment failure, adverse
drug reactions, superinfections, and extra cost. However,
1

School of Pharmacy, College of Health and Medical Sciences, Haramaya
University, Harar, Ethiopia
Corresponding Author:
Mekonnen Sisay, Department of Pharmacology and Toxicology, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University,
PO Box 235, Harar, Ethiopia.
Email: mekonnensisay27@yahoo.com

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