Sodhi Baani, Basu Saurav
Indian Institute of Public Health-Delhi (IIPH-D), Public Health Foundation of India, New Delhi, IND.
Cureus. 2022 Nov 29;14(11):e32017. doi: 10.7759/cureus.32017. eCollection 2022 Nov.
Background Antibiotics, as defined by the World Health Organization (WHO), are pharmaceuticals used to treat bacterial infections. There is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures. There are a few prescriptions audit studies from smaller cities in Northern India, especially those conducted during the COVID-19 pandemic when the unregulated private sector accounted for 90% of antibiotic sales and 75% of healthcare requirements. The study objectives were to determine the rate of outpatient antibiotic prescription and adherence to WHO drug indicators in prescriptions to pediatric outpatients in private healthcare facilities in India. Methodology This cross-sectional survey was conducted over three months (January to March 2022) in the outpatient setting of a private pediatric hospital in Kanpur, a city having a population of nearly three million population located in the state of Uttar Pradesh in India. Prescriptions of children aged <10 years with a history of onset of complaint <14 days were included in this audit. Prescriptions were numbered; data were collected using a specially designed semistructured, pretested prescription audit checklist; and the recommended WHO indicators were also calculated. Data were entered using CSPro (U.S. Census Bureau, Washington, DC, USA) and analyzed using STATA 15 (StataCorp LLC, College Station, TX, USA). Results This study observed an antibiotic prescription rate of 65.75%, which was higher than the WHO-recommended value, which might indicate indiscriminate usage of antibiotics in the setting. Out of the 144 antibiotic medications prescribed, none were generic and all the antibiotics were prescribed presumptively. The most commonly prescribed medicines were cefpodoxime, azithromycin, and ofloxacin, which were primarily used to treat cough and stomach infections. Conclusions This antibiotic audit conducted in a private hospital outpatient setting in a city in Northern India during the Omicron wave of the COVID-19 pandemic found nongeneric, predominantly oral, presumptive antibiotic prescriptions in nearly two out of three young pediatric patients. Improvement in prescribing practices through regulation, monitoring, and antibiotic stewardship in low-resource settings is urgently warranted to curb the impending global pandemic of antimicrobial resistance.
背景 世界卫生组织（WHO）定义，抗生素是用于治疗细菌感染的药物。人们越来越认识到，儿童不适当的抗生素处方与严重药物不良事件发生率上升和医疗支出增加有关。印度北部一些较小城市有一些处方审核研究，特别是在新冠疫情期间进行的研究，当时不受监管的私营部门占抗生素销售额的90%和医疗保健需求的75%。研究目的是确定印度私立医疗机构中儿科门诊患者的门诊抗生素处方率以及处方是否符合WHO药物指标。方法 这项横断面调查于2022年1月至3月的三个月内在印度北方邦坎普尔市一家私立儿科医院的门诊进行，该市人口近300万。本次审核纳入了年龄<10岁、主诉发病史<14天的儿童处方。处方进行编号；使用专门设计的半结构化、经过预测试的处方审核清单收集数据；并计算WHO推荐的指标。数据使用CSPro（美国人口普查局，华盛顿特区，美国）录入，并使用STATA 15（StataCorp有限责任公司，大学城，德克萨斯州，美国）进行分析。结果 本研究观察到抗生素处方率为65.75%，高于WHO推荐值，这可能表明该环境中抗生素的滥用。在开出的144种抗生素药物中，没有一种是通用名药物，所有抗生素都是推定处方。最常开具的药物是头孢泊肟、阿奇霉素和氧氟沙星，主要用于治疗咳嗽和胃部感染。结论 在新冠疫情奥密克戎毒株流行期间，在印度北部一个城市的私立医院门诊进行的这项抗生素审核发现，近三分之二的小儿患者使用的是非通用名、主要为口服的推定抗生素处方。迫切需要通过在资源匮乏地区进行监管、监测和抗生素管理来改善处方行为，以遏制即将到来的全球抗菌药物耐药性大流行。
