Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa

• Published in: IJID regions Vol. 10; pp. 151 - 158
• Main Authors: Moore, David P., Chetty, Terusha, Pillay, Ashendri, Karsas, Maria, Cloete, Jeané, Balakrishna, Yusentha, Reddy, Tarylee, Archary, Moherndran, van Kwawegen, Alison, Thomas, Reenu, Nakwa, Firdose L., Waggie, Zainab, Magrath, Stephanie, Goga, Ameena, Jeena, Prakash
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2024
• Subjects: Africa; Antimicrobial prescribing audit; AWaRe classification; Hospitalised children; Antimicrobial prescribing audit; Hospitalised children; AWaRe classification; Africa
• DOI: 10.1016/j.ijregi.2023.12.004
• ISSN: 2772-7076

•Antimicrobial prescribing to hospitalised children in South Africa is under-studied.•We prospectively audited antimicrobial use in three South African academic centres.•Marked differences in prescribing practice were noted across institutions.•Watch and Reserve antibiotic prescriptions were associated with complex or severe illness.•Antifungals were prescribed to treat hospital-acquired infections, and as medical prophylaxis. South Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. We conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. We recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). Guidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.