Microsoft word - swalha2.doc

Ansam F. Sawalha, Ghada O. Al-Bishtawi, Laila S. Al- Khayyat, Waleed M. Sweileh* , Rowa J. Al-Ramahi & Pattern of Parenteral Antimicrobial Prescription among Pediatric Patients in Al-Watani Government Hospital in Palestine. Abstract
Objective: No studies were carried out in Palestine to investigate the antimicrobial prescribing
among hospitalized pediatric patients. The objective of this study was to audit and therapeutically analyze the pattern of parenteral antimicrobial prescriptions among pediatric patients in Al- Watani government hospital in Palestine. Such audit will be of great value to clinician and health Material and Methods: Data on antimicrobial prescribing were collected for 30 consecutive
days for all pediatric patients admitted to Al-Watani government hospital. Data on antimicrobial prescribing were entered and analyzed using Statistical Package for Social Sciences (SPSS) program. Analysis was done for age, sex, diagnosis, site of infection, number of antimicrobial agents given, how many times have the drug regimen been changed and the frequency of Results: Three hundred and forty pediatric patients were admitted to Al-Watani government
hospital during the study period. Gastroenteritis was the most common cause of hospitalization, while upper respiratory tract infection (URTI) was the most common cause of parenteral antimicrobial agent administration. Two hundred and ten (61.8%) patients received parenteral antimicrobial agents while 16 (4.7%) received both parenteral and oral antimicrobial agents. Single antimicrobial agent was prescribed for 172 (76.1%) patients. Cefuroxime was the main single antimicrobial agent used, it was administered to 70/226 (31%) patients. Conclusion: Treatment patterns used for most patients were nearly according to current
therapeutic recommendations. However, improving the availability of rapid diagnostic methods to differentiate between viral and bacterial infections is suggested to reduce empiric therapy numbers by antimicrobial agents so as to decrease chance for drug resistance. Key words: Antimicrobials, Pediatrics, Prescription, Palestine.
effective and play an important role in the ccording to the 2003 annual report issued by the Palestinian Ministry of Health, 437 have serious consequences. The worldwide, deaths among infants and children less than multi-drug resistant microorganisms were five years were caused by infectious diseases (1). This suggests that more attention is widespread use of antimicrobial agents in needed for the investigation of the protocols both inpatients and outpatients (2, 3). For there is an emergence of resistant strains of Streptococcus pneumoniae to antimicrobial population groups to contract illnesses. increasing (4). The emergence of multi-drug included patient's file number, age, sex, resistant microorganisms might lead to more diagnosis, site of infection, and the drug problem associated with the irrational use of (SPSS version 11) program in terms of age, antimicrobials especially among pediatrics is sex, diagnosis, site of infection, number of the ability of strong antibiotics to disturb the colonization of gastro-intestinal microflora times have the drug regimen been changed, which may induce serious clinical symptoms Diagnosis was classified as being either single, mixed, unidentified or no infection. resistant pathogens and other complications infection is diagnosed, “mixed” is used strict antibiotic policy and rational use of “unidentified” infection was used when the antimicrobial agents which also have shown patient was given antimicrobial agents but to be cost saving and to prolong antibiotic utilization in Palestine in general and among Data analysis showed that 266/340 (7 %) of pediatrics in particular. Such knowledge is the admitted patients were below five years of age. One third of those patients were identify targets for improving antimicrobial utilization and thus optimizing costs, therapy admitted males were 203 representing (60%) and disease management. The objective of this study was to investigate the use of infection who were admitted to the hospital Hospital in Nablus which is a referral center single infection while mixed infections were for pediatrics from northern West Bank, and diagnosed in 28 patients (8.3%). Further to determine if the current utilization was infections account for most of the diagnosed Material and Methods
This study was carried out in the pediatric admitted, 210 (61.8%) received parenteral anti-infective therapy, 16 (4.7%) received department is supervised by board certified both parenteral and oral treatment, 7 (2.1%) pediatricians and pediatric-board-eligible (31.5%) didn't receive any anti-infective therapy. Beta-lactams, metronidazole and admitted pediatric patients and was carried aminoglycosides constitute the majority of out for thirty days starting from October 10th administered anti-infective agents. Among the 226 patient whom received parenteral prescriptions for all admitted patients within antimicrobial agents, cephalosporins were the 30 days were reviewed. Access to patient medical files was made possible based on an cephalosporin, was used among a total of 70 (31%) patients. It was repeatedly used for chest infection, unidentified infections and pneumonia. Ceftriaxone, a third generation cephalosporin, was used among a total of 56 (24.8%) patients. It was used for meningitis, unidentified infections and upper respiratory tract infections (URTI). Cefazolin, a first approximately 18% of the admitted patients. generation cephalosporin, was mainly used The combination consisted of ceftriaxone + for gastroenteritis. Crystalline penicillin, a parenteral penicillin, was used in 21 (9.3%) patients, half of them were having tonsillitis, patients mainly for URTI. Metronidazole, a chemotherapeutic agent effective against In the treatment of single infections, no anaerobic bacteria and certain parasites, was fixed therapeutic regimen was employed as used in 21 (9.3%) patients for treatment of shown in Table-2. For most of the admitted hospital. However in 8.2% of the cases the Table 1. Data distribution based on site of
microbiological culture; rather, it was based infection. GI: Gastrointestinal Infection, URTI:
on patient's clinical response, as culture Upper Respiratory Tract Infection, LRTI: Lower sensitivity test was done only for 5.6% of Respiratory Tract Infection, CNS: Central Nervous System, UTI: Urinary Tract Infection. Frequency
GI Infection
Inappropriate utilization of antimicrobial agents forced many researchers to evaluate No Infection
the antimicrobial consumption in order to restrict and control the risk of antibiotic Unidentified
worldwide to assess this problem. A study CNS Infection
done in a tertiary hospital in Spain showed Prophylactic
extensive inappropriate third generation guidelines for rational antibiotic use were Infection
developed, but it haven't been implemented Skin Infection
practice and antibiotic prescribing pattern at a general hospital in Nigeria revealed that Liver Infection
appreciable gap in knowledge with respect CNS+ Kidney
healthcare professionals (10). Prescription Infection+ URTI
audit reveals that it's possible to achieve a change in the utilization of antibiotic in treatment of RTIs (11). Getting audit and feed back information about clinical records administered to patients was also assessed. has been shown to decrease inappropriate Single antimicrobial therapy was used in utilization of antibiotics. For continuous benefit these records should be continuously the predominant single antimicrobial therapy updated (12). Pharmacists should have a role used (15%), followed by cefazolin (9.4%), They can play a major role through clinician prescription was maximum in Paediatrics, education and focused clinical services (13). pattern in an Indian tertiary hospital has cefotaxime and cloxacillin were the most
Table 2. The most common drug regimen used

1 (12.5%)
Ceftriaxone+Metronidazole+ TMP/SMX 2 (3%)
Otitis Media
Erythromycin+Cefuroxime+Vancomycin 1 (7%)
Crystalline Penicillin
Crystalline Penicillin
million children worldwide die each year from acute respiratory illnesses, many of rates than penicillin (24). In this study, it Streptococcus pneumoniae are the most was noted that most cases of tonsillitis pneumonia (16). Mycoplasma pneumoniae and Chlamydia pneumoniae can also rotavirus infection (27). The cornerstone for treatment of gastroenteritis is fluid Antibiotic therapy use in gastroenteritis erythromycin for 5 years and older (17). ceftriaxone or cefotaxime ± macrolide ± Campylobacter (Macrolides), while no infections (30). In this study, antibiotics, one third of the admitted patients having gastroenteritis, although it's not indicated stool culture makes it difficult to judge could be used in children younger than 2 the rationality of antibiotic use in these months of age (19) or in hospital acquired Escherichia coli are responsible for most Pseudomonas aeruginosa (32). In Gaza constitute the majority of cases of URTI. proportion of isolated pathogens causing in tonsillitis is group A Streptococcus infections were resistant to amoxicillin, have faced was the non specific terms used that a susceptibility test is a must before in diagnosis as chest infection and upper prescribing these agents (33). In this study, all respiratory tract infection. Chest infection urinary tract infected patients received could be pneumonia or bronchiolitis, while antibiotics either as monotherapy or as part upper respiratory tract could be otitis media, Physicians need to be more specific in their generation cephalosporin, cefuroxime. In general, the regimens prescribed for the utilization of parenteral antimicrobial agents Meningitis is a major cause of mortality and among pediatrics in a pediatric ward, studies on which are relatively lacking. This study especially among countries where effective may be the base for more specific research vaccines are not available. Streptococcus in the future. Antimicrobial agents were used for both bacterial and viral infection. monocytogenes are the causes of bacterial meningitis in children younger than 3 month diagnostic methods to differentiate between viral and bacterial infections is suggested to Streptococcus pneumoniae or Hemophilus influenza are the active agents in older children (34, 35). For the management of bacterial meningitis in patients less than 3 month old, ampicillin plus a broad spectrum implemented were found to be according to cephalosporine (cefotaxime or ceftriaxone) cephalosprine alone is used in age group of References
3 month -18 years old. (35). Acyclovir should [1]. Health status in Palestine: ministry of health be added to the treatment regimen if Herpes Simplex Virus (HSV) infection is suspected (36) but in our country HSV is not among the [2]. Gupta M, Malhorta S, Chandra KK , Sharma causative agents of meningitis, so there is no N, Pandhi P. Utilization of parenteral anti- need for acyclovir. Instead enterovirus is the infective agents in the medical emergency unit of a tertiary care hospital: an observational study. region (37) for which no specific therapy is available (30). In our study there were 10 Puncture (LP), 7 cases were suspected to be [3]. Jarvis WR. Preventing the emergence of multidrug-resistant microorganisms through bacterial. Lumber Puncture (LP) was done antimicrobial use controls: the complexity of the to confirm the diagnosis of meningitis but problem. Infect Control Hosp Epidemiol. 1996 meningitis cases were treated as if they were [4]. Greenberg D, Dagon R, Muallem M, Porat streptococcus pneumoniae clones in Israel. J Clin Conclusions
Based on what we have found, the treatment [5]. Arvola T, Laiho K, Torkkeli S, Mykkanen of infectious diseases among hospitalized antibiotic-associated diarrhea in children with respiratory infections: a randomized study. children. Curr Opin Pediatr. 2005 Feb;17(1):111- Pal evski G, Betica-Radi L. Antimicrobial Community-acquired pneumonia in infants and utilization and bacterial resistance at three different hospitals. Eur J Epidemiol. 2001;17(4): pneumonia in children. N Engl J Med. 2002 Epidemiological observations of the judicious use of antibiotics in a pediatric teaching hospital. [18]. Jadavji T, Law B, Lebel MH, Kennedy WA, Gold R, Wang EE. A practical guide for the diagnosis and treatment of pediatric pneumonia. palcevski G. Antibiotic utilization at the university hospital after introducing an antibiotic [19]. Nascimento-Carvalho CM, Souza-Marques HH. Recommendation of the brazilian society of pediatrics for antibiotic therapy in children and [9]. Pinto Pereira LM, Phillips M, Ramlal H, cephalosporin use in a tertiary hospital in Port of Spain, Trinidad: need for antibiotic policy. BMC [20]. Lynch JP. Hospital-acquired pneumonia. [10]. Chukwuani CM, Onifade M, Sumonu K. [21]. Bradley JS. Management of community- prescribing pattern at a general hospital in acquired pediatric pneumonia in an era of Nigeria. Pharm World Sci. 2002 Oct;24(5):188- increasing antibiotic resistance and conjugate [11]. Melander E, Bjorgell A, Bjorgell P, Ovhed I, Molstad S. Medical audit changes physicians' [22]. Mohan S, Dharamraj K, Dindial R, Mathur prescribing of antibiotics for respiratory tract D, Parmasad V, Ramdhanie J, et al. Physician infections. Scand J Prim Health Care. 1999 behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West [12]. Seaton RA, Nathwani D, Phillip G, Millar Indies Ann Clin Microbiol Antimicrob. 2004 Jun R, Davey P. Clinical record keeping in patients receiving antibiotics in hospital. Health Bull [23]. Berner R. Otitis media and tonsillitis-2 of the most frequent pediatric diagnoses. Ther [13]. Dickerson LM, Mainous AG 3rd, Carek PJ. The pharmacist's role in promoting optimal antimicrobial use. Pharmacotherapy. 2002 tonsillopharyngitis. J Antimicrob Chemother. [14]. Sharma D, Reeta K, Badyl DK, Garg SK, Bhargava VK. Antimicrobial prescribing pattern [25]. Casey JR, Pichichero ME. Meta-analysis of in an Indian tertiary hospital. Indian J Physiol cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics. 2004 Apr;113(4):866-882. [15]. Klig JE, Shah NB. Office pediatrics: current issues in lower respiratory infections in tonsillopharyngitis: a 5-day course of cefuroxime [32]. Pape L, Gunzer F, Ziesing S, Pape A, axetil versus a 10-day course of penicillin V. Offner G, Ehrich JH. Bacterial pathogens, results depending on the children's age. resistance patterns and treatment options in community acquired pediatric urinary tract infection. Klin Padiatr. 2004 Mar-Apr;216(2):83- gastroenteritis in children. Aust Fam Physician. Antibiotic Resistance of Bacteria Associated [28]. Eliason BC, Lewan BR. Gastroenteritis in children: principles of diagnosis and infections in the southern area of the Gaza Strip. [34]. Behrman RE, Kilegman RM, JensonHB. Nelson text book of pediatrics. 17th ed. Provisional Committee on Quality Improvement, Philadelphia, Pennsylvania: Saunders, Elsevier Subcommittee on Acute Gastroenteritis. Practice gastroenteritis in young children. Pediatrics. [35]. Quagliarello VJ, Scheld WM. Treatment of Bacterial Meningitis. N Engl J Med. 1997 Mar Pickering LK; AAP Committee on Infectious Diseases.26th ed; Elk Grove Village;2003.P.275- Aseptic meningitis in the new born and young [31]. Lau SM, Peng MY, Chang FY. Resistance rates to commonly used antimicrobials among [37]. Meqdam MM, Khalousi MM, Al-Shurman A. Enteroviral meningitis in northern Jordan: bacteremic community-acquired urinary tract prevalence and association with clinical findings. infection. J Microbiol Immunol Infect. 2004 * Corresponding author:


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If you are confused about women's hormone (estrogen) replacement therapy, it is perfectly understandable. Every headline a woman reads seems to contradict the either previous headline or her own doctor. Some sources refer to "menopause," and others to "perimenopause," and yet others to hormonal imbalance. Women's different health situations bring on other questions, such as, "I

Microsoft word - 2484-d-09.doc

Expediente 2484-D-09 H. Cámara de Diputados de la Nación PROYECTO DE LEY Texto facilitado por los firmantes del proyecto. Debe tenerse en cuenta que solamente podrá ser tenido por auténtico el texto publicado en el respectivo Trámite Parlamentario, editado por la Imprenta del Congreso de la Nación. El Senado y Cámara de Diputados,. Publicidad Electoral y de Actos

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