A study on antibiotic prescription among the hospitalized pediatric patients at a referral center in Puducherry, India


  • M. Bala Gopal Department of Pediatrics, Sri Manakulavinayagar Medical College and Hospital, Puducherry, India
  • P. Thiyagarajan Department of Pediatrics, Sri Manakulavinayagar Medical College and Hospital, Puducherry, India
  • Vinayagamoorthy Venugopal Department of Community Medicine, Sri Manakulavinayagar Medical College and Hospital, Puducherry, India
  • Venkata Naveen Kumar Department of Pharmacology, Sri Manakulavinayagar Medical College and Hospital, Puducherry, India




Antibiotic, Microbial, Resistance


Background: Antimicrobial resistance has reached to a significant proportion globally. This antimicrobial resistance increases the cost of health care in addition to the existing burden of the prevalence of infectious disease in developing countries. We need to have institutional protocols based on the standard guidelines. It is important for the clinician to use antibiotics only when it is necessary. The aim of the study was to analyze the rationality of the antibiotics used among the hospitalized children in the referral centre located in the rural area, to evaluate the pattern of antibiotics prescribed among the hospitalized children and to find out the factors associated with the usage of antibiotics among them.  

Methods: Analytical, cross sectional study was performed on all patients admitted to the inpatient pediatric medical service at a referral centre situated in the rural part of the Puducherry, India during the period from July 2015 to June 2016.

Results: 959 children were included in our study.607 children belong to less than 5 years of age group. Overall 60% of the children have received either oral or parenteral antibiotics. Based on the categorization of children as per the final clinical diagnosis children requiring antibiotic, can be used and not required are 13% (125), 38.6% (370) and 48.4% (464) respectively. Respiratory, gastrointestinal and systemic infectious diseases were the major group of cases admitted in our centre. Antibiotic use in respiratory and systemic infectious disease were maximum with 248 (70.1%) and 179 (71.6%) respectively. Among the antibiotics cephalosporin, penicillin group and azithromycin constitute more than 90% of the antibiotics prescribed cases.

Conclusions: Overuse of antibiotic is universal and seen in both developed and developing countries. This increases the cost of treatment and increases the chances of microbial resistance. As per the W.H.O. recommendations surveillance system is required in all the hospitals to assess the antibiotic use and to monitor the prevalence of microbial resistance. 

Author Biography

M. Bala Gopal, Department of Pediatrics, Sri Manakulavinayagar Medical College and Hospital, Puducherry, India

associate professor,department of pediatrics.


Cantas L, Shah SQA, Cavaco LM, Manaia C, Walsh F, Popowska M, et al. A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Front Microbiol. 2013;4:96.

The world medicine situation 2011. Available at http://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch14_wRational.pdf. Accessed on 12 July 2016.

Worldwide country situation analysis. Available at http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf?ua=1. Accessed on 12 July 2016.

Lee CR, Hwan C, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10:4274-305.

Bharathiraja R, Sridharan S, Chelliah LR, Suresh S, Senguttuvan M. Factors affecting antibiotic prescribing pattern in pediatric practice. Indian J Pediatr. 2005;72(10):877-9.

Using indicators to measure country pharmaceutical situations. Available at http:// www.who.int /medicines/publications/WHOTCM2006.2A.pdf. Accessed on 12 November 2016.

Sharma S, Bowman C, Karan B, Singh N. Antibiotic prescribing patterns in the pediatric emergency department at Georgetown public hospital corporation: a retrospective chart review. BMC Infect Dis. 2016;16(1):170.

Ahmed AM, Awad AI. Drug use practices at pediatric hospitals of Khartoum State, Sudan. Ann Pharmacother. 2010;44(12):1986-93.

Fadare J, Olatunya O, Oluwayemi O. Drug prescribing pattern for under-fives in a paediatric clinic in south-western Nigeria. Ethiop J Health Sci. 2015;25(1):73-8.

Akhtar MS, Vohora D, Pillai KK, Dubey K. Drug prescribing practices in paediatric department of a North Indian university teaching hospital. Asian J Pharmaceutical Clinical Research. 2012;5(1):146-9.

Fisher BT, Meaney PA, Shah SS, Irwin SA, Grady CA, Kurup S, et al. Antibiotic use in pediatric patients admitted to a referral hospital in Botswana. Am J Trop Med Hyg. 2009;81(1):129-31.

The challenge of antibiotic resistance. Available at http://www.chiro.org/LINKS/FULL/Challenge_of_Antibiotic_Resistance.shtml. Accessed on 17 December 2016.

Antimicrobial resistance. WHO. Available at http://www.who.int/mediacentre/factsheets/fs194/en/. Accessed on 13 November 2016.

Sigvard MO, Cecilia STA, Lundborg LBSY, Karin A, Karlsson, Otto C. Antibiotic prescription rates vary markedly between 13 European countries. Scand J Infect Dis. 2002;34:366-71.

WHO global strategy for containment of antimicrobial resistance. Available at http:// www. who.int/csr/resources/publications/drugresist/en/EGlobal_Strat.pdf. Accessed on 10 December 2016.

Liang X, Jin C, Wang L, Wei L, Tomson G, Rehnberg C, et al. Unnecessary use of antibiotics for inpatient children with pneumonia in two counties of rural China. Int J Clin Pharm. 2011;33(5):750-4.

Ołdak E, Rozkiewicz D, Sulik A, Pogorzelska E, Alhwish MA. Antibiotics use for acute gastroenteritis in ambulatory care of children before and after implementation the healthcare system reform in Poland. Pol Merkur Lek Organ Pol Tow Lek. 2006;20(116):155-8.

Rad LV, Alekhya M. Prescribing pattern of antibiotics in pediatric inpatient department of a tertiary care teaching hospital in Bangalore. 2015;4:26-32.

Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C, et al. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey. PloS One. 2010;5(11):14011.

Arulmoli SK, Sivachandiran S, Perera BJC. Prescribing patterns of antibiotics for children before admission to a paediatric ward in Jaffna Teaching Hospital. Sri Lanka J Child Health. 2009;38:121-3.

Andersson DI, Levin BR. The biological cost of antibiotic resistance. Curr Opin Microbiol. 1999;2(5):489-93.

Antibiotic prescribing in ambulatory pediatrics in the United States. Available at http://www.wellnessresources.com/studies/antibiotic_prescribing_in_ambulatory_pediatrics_in_the_united_states/. Accessed on 12 July 2016.

Pennie RA. Prospective study of antibiotic prescribing for children. Can Fam Physician Med Fam Can. 1998;44:1850-6.

Gupta R, Sachdev HPS, Shah D. Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness between the ages of one week to two months. Indian Pediatrics. 2000;37:383-90.

Harbarth S, Samore MH. Antimicrobial resistance determinants and future control. 2005;11(6):794-800.






Original Research Articles