Impact of an antimicrobial resistance control program: pre- and post-training antibiotic use in children with typhoid fever
Abstract: Inappropriate use of
antibiotics may lead to antimicrobial resistance. In 2012, Dr. Soetomo Hospital
conducted training for pediatric residents on the proper use of antibiotics to
limit antimicrobial resistance.
Objective To evaluate the impact of a rational, antibiotic-use training
program for pediatric residents on their antibiotic prescriptions for patients
with typhoid fever.
Methods A cross-sectional, analytic study was conducted. We collected
data from children with typhoid fever who were hospitalized in Dr. Soetomo
Hospital, pre- and post-training on antibiotic prescriptions. Children with
other known bacterial infections or who were discharged on request were
excluded. Antibiotic prescriptions were evaluated using Gyssens algorithm based
on the local protocol. Chi-square test was used to compare the quality of
antibiotic prescriptions, before (year 2012) and after (year 2013) the
training.
Results Forty-nine patients with 67 prescriptions in 2012 and 34 patients
with 48 prescriptions in 2013 fulfilled the inclusion criteria. Patients’ ages
ranged from 1-18 years. Diagnoses of uncomplicated and complicated typhoid were
found in 74% and 26% of subjects, respectively. First line (chloramphenicol,
thiamphenicol, ampicillin, trimetroprim and sulfametoxazol) and second line
(ceftriaxone and cefixime) use were 72% and 28%, respectively. All patients
were discharged in good condition. Appropriate use of antibiotics was noted in
61% of subjects in 2012 and in 81% of subjects in 2013 (P=0.036). The most
common type of error in 2012 and 2013 was dosage imprecision (25% and 17%,
respectively).
Conclusion Training on appropriate use of antibiotics significantly
improved the quality of antibiotics prescribed in children with typhoid fever
in Dr. Soetomo Hospital.
Author: Elfrida A. Rachmah,
Maftuchah Rochmanti, Dwiyanti Puspitasari
Journal Code: jpkedokterangg160113
