116: Antibiotic Prescribing Patterns in the Pediatric Emergency Department at Georgetown Public Hospital Corporation

Abstract

BACKGROUND: Recent years have seen an uncontrolled rise in antimicrobial- resistant organisms, leading to increased morbidity, mortality, and healthcare costs. The impact of antimicrobial resistance is greatest on low-income countries, which face the double burden of fewer antibiotic choices and higher rates of infectious disease. Currently, Guyana has no national policy on rational prescribing. The WHO has developed prescribing indicators to detect barriers to good antimicrobial stewardship. There has been no previous research on antibiotic use in children in an outpatient setting in Guyana. OBJECTIVES: To characterize antibiotic prescribing patterns in children discharged from the emergency department at Georgetown Public Hospital Corporation (GPHC), as per WHO prescribing indicators. DESIGN/METHODS: A retrospective chart review of pediatric patients (aged one month - 13 years) seen in the GPHC emergency department between January and December 2012 was conducted. Patients who absconded from hospital prior to receiving therapy were excluded. Outpatient prescriptions for eligible patients were reviewed. Patient demographics, diagnosis, and drugs prescribed were recorded. If antibiotics were prescribed, the antibiotic class, dose, route, frequency and duration of therapy was recorded. The following WHO Prescribing Indicators were calculated: i) average number of drugs prescribed per patient encounter, ii) percentage of encounters with an antibiotic prescribed, iii) percentage of antibiotics prescribed by generic name, and iv) percentage of antibiotics prescribed from essential drugs list or formulary. RESULTS: 811 patient encounters were included in the study. The mean patient age was 5.55 years. 59.6% (n= 483) patients were male. An average of 2.5 drugs were prescribed per encounter (WHO standard is 2.0). One or more antibiotic was prescribed during 36.9% (n = 299) of all encounters (WHO standard is 30%). 90.83% of antibiotics were prescribed from the essential drugs formulary list and 30% of the prescriptions included the drug's generic name. The average duration of antibiotic therapy was 5.73 days. Of the 360 antibiotics prescribed, 74.7% (n= 269) were broadspectrum. B-lactam penicillins were prescribed most frequently (51.4%), with amoxicillin being the most popular choice (33.9%). The most common diagnoses were injuries (25.8%), respiratory infections (19.5%), asthma (16.9%) and gastrointestinal infections (12.1%). CONCLUSION: Per WHO prescribing indicators, the pediatric emergency department at GPHC has higher than standard rates of antibiotic use and polypharmacy. Strengths of the department include adherence to the essential drug formulary and preference for generic agents whenever possible. While it was beyond the scope of this study, these results suggest that antibiotics are often inappropriately prescribed for non-infectious pediatric diagnoses.