Antibiotic Prescribing Patterns by Health Care Providers in Pediatric Outpatients: A Prospective Observational Study

Abstract

Objectives: To audit the patterns and quality of antibiotic prescription for children in the outpatient department (OPD). Methods: This prospective observational study was conducted on the tertiary care outpatient department of a teaching hospital. One thousand prescriptions for children between 1 month and 15 years of age, who attended the outpatient department of a tertiary care teaching hospital between April 2018 and May 2019, were included. The quality of prescriptions was assessed based on 12 pretest parameters. One score was given to each correctly written parameter, and total scores were categorized as poor (0 - 4), average (5 - 8), and good (9 - 12). The core prescribing indicators presented by the world health organization (WHO) were used to analyze antibiotic prescribing patterns. The data were analyzed using open-source Epidata software. Results: Out of 1000 prescriptions, quality was average in 490 (49%) and poor in 46 (4.6%) prescriptions. The average number of medicines prescribed per encounter was 3.5 (reference value < 2). The medicines were prescribed by their generic names in 27.3% of the prescriptions (reference value 100%). Antibiotics and injections appeared in 65% (reference value < 30%) and 6% (reference value < 20%) of the prescriptions. The ratio of prescription from a list of essential medicines was 15% (reference value 100%). According to the prescriber profile, the rate of prescribing an antibiotic was 63% by postgraduates in pediatrics, 70% by MBBS, and 90% by AYUSH doctors (reference value < 30%). Conclusions: More than half of the prescriptions could not attain a good score. There is room for improving prescription writing practice. Antibiotic prescription by health care providers, especially AYUSH doctors, needs to be restricted given the high number of antibiotics per prescription. This will limit the indiscriminate use of antibiotics and may be a big step towards achieving the antibiotic stewardship goal.