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Antibiotic use for pneumonia among children under-five at a pediatric hospital in Dhaka city, Bangladesh

Authors Rashid MM, Chisti MJ, Akter D, Sarker M, Chowdhury F

Received 19 April 2017

Accepted for publication 20 June 2017

Published 3 August 2017 Volume 2017:11 Pages 1335—1342

DOI https://doi.org/10.2147/PPA.S140002

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Doris Leung

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Md Mahbubur Rashid,1,2 Mohammod Jobayer Chisti,3 Dilruba Akter,4 Malabika Sarkar,2 Fahmida Chowdhury1

1Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; 2James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh; 3Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; 4Department of Pathology, Shaheed Tajuddin Ahmed Medical College Hospital, Gazipur, Dhaka, Bangladesh

Background: 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.
Methods: 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.
Results: 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 underweight. 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%).
Conclusion: 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.

Keywords: antibiotic use, under-five children, pneumonia, private hospitals, pediatrics, WHO guidelines, Bangladesh

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