Irrational Use of Antibiotics in Management of Acute Watery Diarrhea in Children under 5 years

Background: Diarrheal disease is the second leading cause of death in children under five years. It’s responsible for around 525, 000 deaths of children every year. The use of antibiotics for treatment of pediatric diarrhea has been observed in spite of World Health Organization guidelines which discourage the use of antibiotics for treating acute diarrhea. Here we assess the extent of irrational use of antibiotics in management of acute watery diarrhea among under-five children both at home and health setting. Methods: Children under 5 years of age (n = 147) presenting at Mohammed Al-Amin Hammed Hospital with acute watery diarrhea were included in the study. Background information on the children was collected by questionnaire, including home treatments, and clinical information including symptoms and treatment were provided at hospital. Data were collected and analyzed for associations between variables and use of antibiotics using Chi-square statistic (X2). Results: Among the 147 patients, 87 (59.3%) were males and 60 (40.7%) were females. The mean age of the children was 12 ± 12.1 months. 119(80.9%) were treated as in patient, while 28(19.1%) were treated as outpatient. 61(53%) were admitted because of ongoing losses, (24.3%) admitted because they were malnourished children, 25(21.7%) had some dehydration. (63.7%) didn’t have stool analysis done and only 36.3% had stool analysis done. 110 (76%) received antibiotics, which prescribed by health care provider. Regarding antibiotics, 82(63.4%) were third generation cephalosporin in form of Ceftriaxone, cefotaxime and cefixime, followed by benzyl penicillin and gentamycin injection for 72 (55%), and 24 (18.6%) metronidazole. Use of antibiotics was not influenced by age of the child, reason of admission or stool analysis. The only variable positively associated with antibiotic prescription was diarrhea from one to three days at admission. Conclusion: It is clear that young children presenting with acute watery diarrhea to Mohammed Al-Amin Hammed Hospital are likely to be treated with antibiotics, despite there is being no obvious reason that this treatment is appropriate. Our study results support the need for institution-based antimicrobial stewardship to be implemented to decrease antimicrobial resistance.