Background: The inappropriate, irrational use or misuse of antibiotics is observed in all health systems and in all patients’ groups worldwide, especially for children, where antibiotics continue to be the drugs most commonly prescribed. Methods: A cross-sectional study was conducted in all public pediatric clinics in the Republic of Cyprus, from April to May 2015. A questionnaire was distributed to pediatricians in order to identify the antibiotic prescription practices in common childhood diseases and attitudes towards Pharmacovigilance. The SPSS 19.0 was used for the statistical analysis. In total 42 pediatricians and pediatric residents filled out the questionnaire. Results: A significant percentage of the respondents administered empirical therapy for possible group A streptococcus infection (59.5%), they implemented the “watchful waiting” tactic in acute otitis media (66.7%), whereas 11.9% of them administered antibiotics for the prevention of secondary respiratory tract infections. The majority of physicians did not feel diagnostic uncertainty leading to antibiotics prescribing (90.2%) and their prescribing habits were not influenced by parental demand (80.5%). Although 23.1% of physicians observed often/very often Adverse Drug Reactions (ADRs) after antibiotic administration during their clinical practice, however, 47.6% of the pediatricians declared that they did not report them. Conclusion: Health professionals’ continuing education on the use of therapeutic guidelines and protocols and the development of Pharmacovigilance programs could significantly contribute to the avoidance of the misuse of antibiotics in hospital care as well as to health professionals’ awareness on rational prescribing.
KeywordsAntibiotics’ PrescribingPharmacovigilancePediatriciansAdverse Drug Reactions
Mollahaliloglu, S., Alkan, A., Donertas, B., Ozgulcu, S. and Akicet, A. (2013) Assessment of Antibiotic Prescribing at Different Hospitals and Primary Health Care Facilities. Saudi Pharmaceutical Journal, 21, 281-291. https://doi.org/10.1016/j.jsps.2012.10.004
Viswanad, V., Abraham, S., Abraham, A., Anupama, P.P., Muralidharan, A. and Arya Subash, K. (2010) Confrontational Use of Antibiotics in Pediatric Prescriptions. Deccan Journal of Pharmaceutics & Cosmetology, 1, 52-56.
Amadeo, B.P., Muller, A., Drapier, N., Vankerckhoven, V., Rogues, A.M., Davey, P. and Goossens, H. (2008) Paediatric Antimicrobial Prescribing in 32 Hospitals of 21 European Countries. Journal of Antimicrobial Chemotherapy, 65, 2247-2252. https://doi.org/10.1093/jac/dkq309
Bronzwaer, S.L., Cars, O., Buchholz, U., MÖlstad, S., Goettsch, W., Veldhuijzen, I.K., Jacob, L., Kool, J.L., Sprenger, M.J. and Degener, J.E. (2002) The Relationship between Antimicrobial Use and Antimicrobial Resistance in Europe. Emerging Infectious Diseases, 8, 278-282. https://doi.org/10.3201/eid0803.010192
Goossens, H., Ferech, M., Vander Stichele, R. and Elseviers, M. (2005) Outpatient Antibiotic Use in Europe and Association with Resistance: A Cross-National Database Study. The Lancet, 365, 579-587. https://doi.org/10.1016/S0140-6736(05)70799-6
Shamna, M., Dilip, C., Ajmal, M., Mohan, P., Shinu, C., Jafer, C. and Mohammed, Y. (2014) A Prospective Study on Adverse Drug Reactions of Antibiotics in a Tertiary Care Hospital. Saudi Pharmaceutical Journal, 22, 303-308. https://doi.org/10.1016/j.jsps.2013.06.004
Granowitz, E.V. and Brown, R.B. (2008) Antibiotic Adverse Reactions and Drug Interactions. Critical Care Clinics, 24, 421-442. https://doi.org/10.1016/j.ccc.2007.12.011
Van Grootheest, K., van Puijenbroek, E.P. and de Jong-van den Berg, L.T. (2004) Do Pharmacists’ Reports of Adverse Drug Reactions Reflect Patients’ Concerns? Pharmacy World and Science, 26, 155-1459. https://doi.org/10.1023/B:PHAR.0000026802.81401.bb
Morrison-Griffiths, S., Walley, T.J., Park, B.K., et al. (2003) Reporting of Adverse Drug Reactions by Nurses. The Lancet, 361, 1347-1348. https://doi.org/10.1016/S0140-6736(03)13043-7
Abdel-Latif, M.M. and Abdel-Wahab, B.A. (2015) Knowledge and Awareness of Adverse Drug Reactions and Pharmacovigilance Practices among Healthcare Professionals in Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. Saudi Pharmaceutical Journal, 23, 154-161. https://doi.org/10.1016/j.jsps.2014.07.005
Suyagh, M., Farah, D. and Farha, R.A. (2015) Pharmacist’s Knowledge, Practice and Attitudes toward Pharmacovigilance and Adverse Drug Reactions Reporting Process. Saudi Pharmaceutical Journal, 23, 147-153. https://doi.org/10.1016/j.jsps.2014.07.001
Summary of the Latest Data on Antibiotic Consumption in the EU (2014). http://ecdc.europa.eu/en/eaad/Documents/antibiotics-consumption-EU-data-2014.pdf
Geitona, M., Toska, A., Souliotis, K., Saridi, M. and Demetzos, K. (2015) Antibiotic Prescription Practices of Pediatricians and Pediatric Residents in Hospital Care in Greece. Current Drug Safety, 10, 221-226. https://doi.org/10.2174/1574886310666150602150619
Toska, A., Geitona, M., Souliotis, K., Saridi, M. and Demetzos, K. (2014) Adverse Drug Reaction Reporting Related to the Administration of Antibiotics in Hospitalized Pediatric Patients in Greece. Current Drug Safety, 9, 49-55. https://doi.org/10.2174/15748863113086660064
IBM Corp (2010) IBM SPSS Statistics for Windows. Version 19.0, IBM Corp, Armonk.
Stille, C.J., Rifas-Shiman, S.L., Kleinman, K. and Kotch, J.B. and Finkelstein, J.A. (2008) Physician Responses to a Community-Level Trial Promoting Judicious Antibiotic Use. Annals of Family Medicine, 6, 206-212. https://doi.org/10.1370/afm.839
Moro, M.L., Marchi, M., Gagliotti, C., Di Mario, S. and Resi, D. (2009) Why Do Pediatricians Prescribe Antibiotics? Results of an Italian Regional Project. BMC Pediatrics, 9, 69. https://doi.org/10.1186/1471-2431-9-69
Paluck, E., Katzenstein, D., Frankish, C.J., Herbert, C.P., Milner, R., Speert, D. and Chambers, K. (2001) Prescribing Practices and Attitudes toward Giving Children Antibiotics. Canadian Family Physician, 47, 521-527.
Yagupsky, P. (2006) Selection of Antibiotic -Resistant Pathogens in the Community. Pediatric Infectious Diseases Society, 25, 974-976. https://doi.org/10.1097/01.inf.0000239270.33190.71
Gervaix, A., Egger, M., Lacroix, L. and Harbarth, S. (2007) Pediatricians’ Perception of Antibiotic Use in Children in Two Large Swiss Cities. International Journal of Antimicrobial Agents, 30, 281-283. https://doi.org/10.1016/j.ijantimicag.2007.05.006
Bagshaw, S.M. and Kellner, J.D. (2001) Beliefs and Behaviors of Parents Regarding Antibiotic Use by Children. Canadian Journal of Infectious Diseases, 12, 93-97. https://doi.org/10.1155/2001/250697
Mangione-Smith, R., Elliott, M.N., Stivers, T., McDonald, L.L. and Heritage, J. (2006) Ruling out the Need for Antibiotics: Are We Sending the Right Message? Archives of Pediatrics and Adolescent Medicine, 160, 945-952. https://doi.org/10.1001/archpedi.160.9.945
Panagakou, S., Spyridis, N., Papaevangelou, V., Theodoridou, K., Goutziana, G., Theodoridou, M., Syrogiannopoulos, G. and Hadjichristodoulou, C. (2011) Antibiotic Use for Upper Respiratory Tract Infections in Children: A Cross Sectional Survey of Knowledge, Attitudes and Practices of Parents in Greece. BMC Pediatrics, 11, 60. https://doi.org/10.1186/1471-2431-11-60
Palinke, N. (2004) Prescribing Pattern of Antibiotics in Pediatric Hospital of Kathmandu Valley. Kathmandu University Medical Journal, 2, 6-12.
Bjorkman, I., Berg, J., Roing, M., Erntell, M. and Lundborg, C.S. (2010) Perceptions among Swedish Hospital Physicians on Prescribing of Antibiotics and Antibiotic Resistance. BMJ Quality & Safety, 19, 1-5. https://doi.org/10.1136/qshc.2008.029199
Bharathiraya, R., Sridharan, S., Chelliah, L.R., Saradha, S. and Mangayarkarasi Senguttuvan Institute of Child Health and Hospital (2005) Factors Affecting Antibiotic Prescribing Pattern in Pediatric Practice. Indian Journal of Pediatrics, 72, 877-879. https://doi.org/10.1007/BF02731121
Garcia, C., LIamocca, L.P., Garcia, K., Jiménez, A., Samalvides, F., Gotuzzo, E. and Jacobs, J. (2011) Knowledge, Attitudes and Practice Survey about Antimicrobial Resistance and Prescribing among Physicians in a Hospital Setting in Lima, Peru. BMC Clinical Pharmacology, 15, 11-18.
Reichert, S., Simon, T. and Halm, E.A. (2000) Physicians’ Attitudes about Prescribing and Knowledge of the Costs of Common Medications. Archives of Internal Medicine, 160, 2799-2803. https://doi.org/10.1001/archinte.160.18.2799
Geitona, M., Zavras, D., Hatzikou, M. and Kyriopoulos, J. (2006) Generics Market in Greece: The Pharmaceutical Industry’s Beliefs. Health Policy, 79, 35-48. https://doi.org/10.1016/j.healthpol.2005.11.004
Kareem, N., Oshikoya, A. and Awobusuyi, J. (2009) Perceptions of Doctorstoadverse Drug Reaction Reporting in a Teaching Hospital in Lagos. BMC Clinical Pharmacology, 9, 14. https://doi.org/10.1186/1472-6904-9-14
Gallo, M., Clavenna, A., Bonati, M., Siani, P., Irpino, A., Rossi, F. and Capuano, A. (2012) Active Surveillance of Adverse Drug Reactions in Children in Five Italian Paediatric Wards. Open Journal of Pediatrics, 2, 111-117. https://doi.org/10.4236/ojped.2012.22019
Rushed, A., Wong, I., Cranswick, N., Tomlin, S., Rascher, W. and Neubert, A. (2012) Riskfactors Associated with Adverse Drug Reactions in Hospitalized Children: International Multicentre Study. European Journal of Clinical Pharmacology, 68, 801-810. https://doi.org/10.1007/s00228-011-1183-4
Aagaard, L. and Hansen, E. (2010) Adverse Drug Reactions Reported for Systemic Antibacterials in Danish Children over a Decade. British Journal of Clinical Pharmacology, 70, 765-768. https://doi.org/10.1111/j.1365-2125.2010.03732.x
Lee, J.H., Park, K.H., Moon, H.J., Lee, Y.W., Park, J.W. and Hong, C.S. (2012) Spontaneous Reporting of Adverse Drug Reactions through Electronic Submission from Regional Society Healthcare Professionals in Korea. Yonsei Medical Journal, 53, 1022-1027. https://doi.org/10.3349/ymj.2012.53.5.1022
Impicciatore, P., Choonara, I., Clarkson, A., Provasi, D., Pandolfini, C. and Bonati, M. (2001) Incidence of Adverse Drug Reactions in Paediatric In/Outpatients: A Systematic Review and Meta-Analysis of Prospective Studies. British Journal of Clinical Pharmacology, 52, 77-83. https://doi.org/10.1046/j.0306-5251.2001.01407.x
Choudhary, A., Nivedhitha, S., Radhakrishna, L., Tirumalaikolundusubrimnian, P. and Manicvasagam, S. (2013) Perception of Adverse Drug Reaction among Doctors, Nurses and Pharmacists of a Tertiary Care Rural Teaching Hospital. Internet Journal of Pharmacology, 12, No. 1.
John, L.J., Arifulla, M., Cheriathu, J.J. and Sreedharan, J. (2012) Reporting of Adverse Drug Reactions: An Exploratory Study among Nurses in a Teaching Hospital, Ajman, United Arab Emirates. Daru, 20, 44. https://doi.org/10.1186/2008-2231-20-44
Hasford, J., Goettler, M., Munter, K.H. and Müller-Oerlinghausen, B. (2002) Physicians’ Knowledge and Attitudes Regarding the Spontaneous Reporting System for Adverse Drug Reactions. Journal of Clinical Epidemiology, 55, 945-950. https://doi.org/10.1016/S0895-4356(02)00450-X
Okezie, E. and Olufunmilayo, F. (2008) Adverse Drug Reactions Reporting by Physicians in Ibadan, Nigeria. Pharmacoepidemiology and Drug Safety, 17, 517-522. https://doi.org/10.1002/pds.1597
Sushma, M., Kavitha, R., Divyasree, S., Deepashri, B. and Jayanthi, C.R. (2011) A Questionnaire Study to Assess the Knowledge, Attitude and Practice of Pharmacovigilance in a Paediatric Tertiary Care Center. Journal of Chemical and Pharmaceutical Research, 3, 416-422.