Abstract
BackgroundThere are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial.MethodsRepeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention.Results9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02).ConclusionWe found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN42996612
Highlights
There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings
Treatment guidelines for diarrhoea emphasise that patients be assessed for presence of blood in stool; nonbloody diarrhoea is to be managed with fluids only, while bloody diarrhoea, presumed to be dysentery, should be managed with fluids and antibiotics
We conducted a multi-faceted intervention trial in Kenya aimed at improving key inpatient paediatric care practices spanning assessment, diagnosis and treatment of malaria, pneumonia and non-bloody diarrhoea using 14 process-of-care indicators. The effect of this intervention on these practices has been reported previously [18]. We use these data to investigate whether the intervention reduces inappropriate antibiotic use in the children admitted with non-bloody diarrhoea using a hierarchical modelling approach
Summary
There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only This outcome was not a pre-specified end-point of the main trial. Antibiotic misuse may accelerate acquisition of antibiotic resistance [12] necessitating the use of more expensive alternative drugs [13,14] and is a serious threat to drug therapy of infectious diseases [15,16] It may be associated with missed opportunities to make correct diagnoses and as a result further increase in treatment cost. We use these data to investigate whether the intervention (described subsequently) reduces inappropriate antibiotic use in the children admitted with non-bloody diarrhoea using a hierarchical modelling approach
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