Abstract
Data on antimicrobial consumption among the paediatric population in public hospitals in South Africa are limited. This needs to be addressed to improve future antimicrobial use and reduce antimicrobial resistance rates. This study aimed to quantify antimicrobial usage and to identify and classify which antimicrobials are used in the paediatric population in public sector hospitals in South Africa according to the World Health Organization (WHO) AWaRe list of antimicrobials. A point prevalence survey was conducted among 18 public sector hospitals from nine provinces using a newly developed web-based application. Data were analysed according to the WHO AWaRe list to guide future quality improvement programmes. A total of 1261 paediatric patient files were reviewed, with 49.7% (627/1261) receiving at least one antimicrobial and with 1013 antimicrobial prescriptions overall. The top five antimicrobials included ampicillin (16.4%), gentamicin (10.0%), amoxicillin/enzyme inhibitor (9.6%), ceftriaxone (7.4%) and amikacin (6.3%). Antimicrobials from the 'Access' classification were the most used (55.9%), with only 3.1% being from the 'Reserve' classification. The most common infectious conditions for which an antimicrobial was prescribed were pneumonia (14.6%; 148/1013) and clinical sepsis (11.0%; 111/1013). Parenteral administration (75.6%; 766/1013) and prolonged surgical prophylaxis (66.7%; 10/15) were common concerns. Only 28.0% (284/1013) of prescribed antimicrobials had cultures requested; of which only 38.7% (110/284) of culture results were available in the files. Overall, antimicrobial prescribing is common among paediatric patients in South Africa. Interventions should be targeted at improving antimicrobial prescribing, including surgical prophylaxis, and encouraging greater use of oral antibiotics.
Highlights
Antimicrobial resistance (AMR) is increasing, especially in lowand middle-income countries (LMICs) where the burden of AMR and infectious diseases is greatest [1]
We believe that this study represents one of the first comprehensive, national overviews of paediatric antimicrobial use among public sector hospitals in South Africa
49.7% of the admitted patients received at least one antimicrobial, which is higher than the mean rate reported from the worldwide paediatric Point Prevalence Survey (PPS) (36.7%) [9] and by Fink et al who documented a rate of 24.5% among healthcare facilities in LMICs [5]
Summary
Antimicrobial resistance (AMR) is increasing, especially in lowand middle-income countries (LMICs) where the burden of AMR and infectious diseases is greatest [1]. There are particular concerns in South Africa where there is an increasing incidence of ‘superbugs’ including carbapenemase-producing Enterobacteriaceae and Klebsiella pneumoniae [2]. DeFrancesco et al reported high resistance rates to trimethoprim/sulfamethoxazole (54.0%), penicillin (47.1%) and tetracycline (44.8%) among young children in one province of South Africa [3]. In their study of paediatric patients hospitalised for Escherichia coli bloodstream infections, Malande et al found that none of the E. coli isolates were resistant to carbapenems or colistin [4]
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