Use of Antibiotics within the Integrated Management of Childhood Illness (IMCI): Guidelines in Pediatric Outpatient Settings

Abstract

Background: The success of standardized measures for disease classification and treatment has led disease-specific approaches led WHO and UNICEF to incorporate them into a set of guidelines for the integrated management of childhood illness (IMCI), which includes modules or subsets of guidelines for the recognition and management of children with acute respiratory infections, diarrhea, measles, malaria and other febrile illness, and malnutrition. Objective: To assess the use of antibiotics within the IMCI Guidelines in Pediatric Outpatient Settings of Jinnah Hospital. Methodology: It was a cross-sectional study conducted at Pediatrics OPD Jinnah Hospital from May 1, 2014 – August 21, 2014. The 150 children and their parents / accompanying person fulfilling the inclusion criteria after consultation from pediatric consultation were interviewed regarding their disease status and prescription by the doctor regarding antibiotics and other conditions. All the information was entered in a structured questionnaire. The samples were collected by non-probability / purposive sampling technique. Results: Among 150 children included in study mean age of children was 36 months SD 20.42 months. 60% were male and 40% female. Presenting complaints among children were, 75.0% presented fever, 26.4% had loose motions, 22.3% has vomiting, 20.3% had cough. 12.8% presented with abdominal pain. Among those who received antibiotics, 10% received third generation cephalosporin (ceftriaxone, cefexime), 10.7% penicillin’s (mostly amoxicillin and piperacillin), and 4% ciprofloxacin. 30% received combination of 2 or 3 antibiotics (14.7% combination of ceftriaxone and amikacin (aminoglycoside), According to IMCI guidelines 34% were not appropriately treated, 20.7% received antibiotics when they should not and 13.3% did not received antibiotics when they should have. Conclusion: Their low adherence to integrated management of childhood illness (IMCI) recommendations for prescription of antibiotics in routine outpatient settings the study shows highly prevalent use of third generation cephalosporins.