Dash Sampa, Ali Mohammad, Sultana Eva, Ram Malathi, Perin Jamie, Naz Farina, Roy Bharati, Hasan Abm Ali, Afroze Farzana, Tofail Fahmida, Ahmed Tahmeed, Faruque Asg, Chakraborty Subhra
Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, JHU, Baltimore, MD, USA.
Sci Rep. 2025 Jul 20;15(1):26359. doi: 10.1038/s41598-025-09479-w.
Appropriate healthcare utilization and compliance with the WHO treatment guidelines can significantly reduce diarrhea-related childhood mortality and morbidity, while overuse of antibiotics notably increases antibiotic resistance. We studied care-seeking behavior and antibiotic use for childhood diarrhea by analyzing data from 8294 diarrheal episodes of 1-59-month-old children visiting a tertiary-care hospital in rural Bangladesh. Overall, 55% of the study children received antibiotics, while only 6% had dysentery. Notably, 77% of the antibiotics were obtained from a local pharmacy without a prescription. Antibiotics alone, without zinc or ORS, were used by more children with dysentery than watery diarrhea (15% vs. 9%; p < 0.001). While 85% of the children received ORS, only 7% received zinc and ORS without antibiotics. Children who received antibiotics before seeking care at the hospital had a significantly higher rate of hospitalization than those who did not have antibiotics (20% vs. 13%; p < 0.001). The factors that influenced the caregivers' decision to seek care from the pharmacy were the desire for early recovery, traditional practices, faith in seeking care at pharmacies, and distance to a healthcare facility. Our findings warrant that reducing unnecessary antibiotic consumption requires increasing public awareness and strengthening laws on the sale of over-the-counter antibiotics.
适当的医疗保健利用和遵守世界卫生组织的治疗指南可以显著降低与腹泻相关的儿童死亡率和发病率，而过度使用抗生素则会显著增加抗生素耐药性。我们通过分析孟加拉国农村一家三级护理医院1至59个月大儿童的8294次腹泻发作数据，研究了儿童腹泻的就医行为和抗生素使用情况。总体而言，55%的研究儿童接受了抗生素治疗，而只有6%患有痢疾。值得注意的是，77%的抗生素是从当地药店无处方获得的。与水样腹泻儿童相比，更多患痢疾的儿童仅使用抗生素，而未同时使用锌或口服补液盐（ORS）（15%对9%；p<0.001）。虽然85%的儿童接受了ORS，但只有7%的儿童接受了锌和ORS且未使用抗生素。在医院就医前接受抗生素治疗的儿童住院率显著高于未使用抗生素的儿童（20%对13%；p<0.001）。影响照顾者从药店寻求治疗的决定的因素包括希望早日康复、传统做法、对在药店寻求治疗的信任以及到医疗机构的距离。我们的研究结果表明，减少不必要的抗生素消费需要提高公众意识并加强非处方抗生素销售的法律规定。
