Rashid Md Mahbubur, Chisti Mohammod Jobayer, Akter Dilruba, Sarkar Malabika, Chowdhury Fahmida
Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Patient Prefer Adherence. 2017 Aug 3;11:1335-1342. doi: 10.2147/PPA.S140002. eCollection 2017.
Pneumonia has been the leading cause of morbidity and mortality among children under 5 for more than 3 decades, particularly in low-income countries like Bangladesh. The World Health Organization (WHO) developed a pneumonia case management strategy which included the use of antibiotics for both primary and hospital-based care. This study aims to describe antibiotic usage for treating pneumonia in children in a private pediatric teaching hospital in Dhaka, Bangladesh.
We conducted this cross-sectional study among children <5 years old who were admitted to a private pediatric hospital in Dhaka with a diagnosis of pneumonia in November 2012.
We enrolled 80 children during the study period. Among them, 28 (35.4%) were underweight, 14 (17.7%) were moderately underweight, and 13 (16.5%) were severely under-weight. On the basis of WHO classification (2005), 43 children (54%) had severe pneumonia and 37 (46%) had very severe pneumonia, as diagnosed by the research physician. Among the prescribed antibiotics in the hospital, parenteral ceftriaxone was the most common 40 (50%), followed by cefotaxime plus amikacin 14 (17.5%), cefuroxime 7 (8.8%), ceftazidime plus amikacin 6 (7.5%), ceftriaxone plus amikacin 3 (3.8%), meropenem 2 (2.5%), cefepime 2 (2.5%), and cefotaxime 2 (2.5%).
Despite the WHO pneumonia treatment strategy, the inappropriate use of higher-generation cephalosporin and carbapenem was high in the study hospital. The results underscore the noncompliance with the WHO guidelines of antibiotic use and the importance of enforcing regulatory policy of the rational use of antibiotics for treating hospitalized children with pneumonia. Following these guidelines may help prevent increased antimicrobial resistance.
三十多年来，肺炎一直是五岁以下儿童发病和死亡的主要原因，在孟加拉国等低收入国家尤为如此。世界卫生组织（WHO）制定了肺炎病例管理策略，其中包括在初级和医院护理中使用抗生素。本研究旨在描述孟加拉国达卡一家私立儿科教学医院中治疗儿童肺炎的抗生素使用情况。
我们对2012年11月入住达卡一家私立儿科医院且诊断为肺炎的5岁以下儿童进行了这项横断面研究。
研究期间我们纳入了80名儿童。其中，28名（35.4%）体重不足，14名（17.7%）中度体重不足，13名（16.5%）严重体重不足。根据世界卫生组织（2005年）的分类，经研究医生诊断，43名儿童（54%）患有重症肺炎，37名（46%）患有极重症肺炎。在医院开具的抗生素中，静脉注射头孢曲松最为常见，有40名（50%），其次是头孢噻肟加阿米卡星，有14名（17.5%），头孢呋辛7名（8.8%），头孢他啶加阿米卡星6名（7.5%），头孢曲松加阿米卡星3名（3.8%），美罗培南2名（2.5%），头孢吡肟2名（2.5%），头孢噻肟2名（2.5%）。
尽管有世界卫生组织的肺炎治疗策略，但研究医院中更高代头孢菌素和碳青霉烯类药物的不当使用比例很高。结果强调了不遵守世界卫生组织抗生素使用指南的情况，以及执行合理使用抗生素监管政策以治疗住院肺炎儿童的重要性。遵循这些指南可能有助于预防抗菌药物耐药性增加。
