Prescription days offered for childhood infections by residents and pediatricians in Ethiopia vary from internationally recognized guidelines: Indifference to duration recommendations promotes sub-optimal patient outcomes and antimicrobial resistance

Abstract

Abstract Background: Antimicrobial resistance (AMR) is leading health care in developing countries into a down-ward spiral. Scarcities in clinical microbiology laboratories compounded by lack of awareness on antimicrobial stewardship and unregulated durations of antimicrobial use are leading to sub-optimal clinical outcomes. The objective of the study was to assess recommendations for duration of antimicrobial treatment suggested by pediatric residents and pediatricians in Addis Ababa, Ethiopia in comparison with guidelines published by internationally recognized bodies.Methods: This was a descriptive cross-sectional study conducted from 1st February and 31st July, 2020. Data on durations of antimicrobial prescriptions suggested for infectious syndromes were collected from pediatricians and pediatric residents working and training in Addis Ababa, Ethiopia. Responses on deficiencies and excesses in recommendations for durations of treatment were summarized using descriptive quantitative analysis and their conformity to practice recommended by internationally recognized guidelines was evaluated. Differences between sub-groups was determined by the Mann-Whitney U test (SPSS 25.0). Analyses were done using Statistical package for the social sciences (SPSS) version 20.0 and significant differences ascertained at p-value < 0.05. Results: A total of 88 respondents participated in the study: 48 residents and 40 pediatricians. Many respondents suggested prescription days exceeding guideline recommendations for common pediatric infections; notably for bacterial conjunctivitis, cystitis, cellulitis and lower respiratory infections. Antimicrobial therapy durations often came short of standard recommendations for tonsillopharyngitis, amebiasis and pyomyositis. Pediatricians favored less prescription days for bacterial endocarditis, hospital acquired pneumonia, cystitis and bacterial conjunctivitis. Inter-group differences were significant in prescribing for meningococcal meningitis, otitis media, Candida central line blood stream infections and non-gonococcal septic arthritis. Overall, respondents suggested 11,828.6 prescription days in excess of guideline recommendations.Conclusions: We found prescription days offered by pediatric residents and pediatricians practicing in Addis Ababa, Ethiopia to be beyond or less than durations of therapy recommended by guidelines for most childhood infections. Observance of evidence-based antimicrobial guidelines leads to favorable patient outcomes, fewer drug-related toxicities and prevention of antimicrobial resistance.