Antimicrobial Use Among Hospitalized Neonates and Children; Findings and Implications from a Comprehensive Point Prevalence Survey Among General Tertiary Hospitals in Pakistan

Zia Ul Mustafa,1,2 Muhammad Salman,3 Amer Hayat Khan,1 Sabariah Noor Harun,1 Johanna C Meyer,4,5 Brian Godman4,6 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia; 2Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, 57400, Pakistan; 3Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, 54000, Pakistan; 4Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, 0208, South Africa; 5South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, 0208, South Africa; 6Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, G4 0RE, UKCorrespondence: Brian Godman, Email [email protected]: Antimicrobial resistance is a global health crisis exacerbated by excessive and inappropriate use of antibiotics, especially among low- and middle-income countries including Pakistan. The paediatric population is a key area in view of their vulnerability and excessive prescribing of antibiotics in Pakistan. Consequently, there is an urgent need to robustly assess antimicrobial use among hospitalized neonates and children in tertiary hospitals in Pakistan as they are generally the training centres for new physicians subsequently treating children.Patients and Methods: A point prevalence survey (PPS) was conducted in the children’s wards of 14 tertiary care hospitals in Punjab Province, covering over 50% of the population of Pakistan. This builds on a previous PPS among tertiary care hospitals treating exclusively neonates and children.Results: A total of 1811 neonates and children were surveyed with 1744 patients prescribed antibiotics, a prevalence of 96.3%. A total of 2747 antibiotics were prescribed to these 1744 neonates and children, averaging 1.57 antibiotics per patient. Overall, 57.7% of the patients were prescribed one antibiotic and 27.2% two antibiotics, with 85.6% of antibiotics administered parenterally. Over a third (34.4%) of the antibiotics were prescribed prophylactically, with 44.7% of them for surgical procedures. Among those prescribed antibiotics for surgical procedures, 75.2% were prescribed for more than one day. Overall, 92.2% of antibiotics were prescribed empirically, with 86.2% prescribed without mentioning the rationale for their choice in the notes, with 77.6% having no stop date. Respiratory tract infections were the most common indication (43.4%). Staphylococcus species (36.0%) were the most common pathogen with limited Culture and Sensitivity Testing performed. Three quarters (75.2%) of antibiotics were from the Watch list, and 24.4% were Access antibiotics.Conclusion: A very high prevalence of antibiotic use among neonates and children in tertiary hospitals in Pakistan, including Watch antibiotics, mirroring previous studies. Consequently, initiatives including antimicrobial stewardship programmes are urgently needed to address current inappropriate prescribing.Keywords: point prevalence survey, tertiary hospitals, children, neonates, antibiotics, AWaRe classification, Pakistan