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

David P Moore; Terusha Chetty; Ashendri Pillay; Maria Karsas; Jeané Cloete; Yusentha Balakrishna; Tarylee Reddy; Moherndran Archary; Alison van Kwawegen; Reenu Thomas; Firdose L Nakwa; Zainab Waggie; Stephanie Magrath; Ameena Goga; Prakash Jeena

doi:10.1016/j.ijregi.2023.12.004

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

IJID Reg. 2023 Dec 20:10:151-158. doi: 10.1016/j.ijregi.2023.12.004. eCollection 2024 Mar.

Authors

David P Moore^{1

2}, Terusha Chetty³, Ashendri Pillay⁴, Maria Karsas⁵, Jeané Cloete⁵, Yusentha Balakrishna⁶, Tarylee Reddy⁶, Moherndran Archary⁴, Alison van Kwawegen¹, Reenu Thomas¹, Firdose L Nakwa¹, Zainab Waggie¹, Stephanie Magrath⁷, Ameena Goga^{5

8}, Prakash Jeena⁴

Affiliations

¹ Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
² South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
³ HIV And Other Infectious Diseases Unit, South African Medical Research Council & Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
⁴ Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa.
⁶ Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa.
⁷ Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa.
⁸ South African Medical Research Council, Pretoria, South Africa.

Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: AWaRe classification; Africa; Antimicrobial prescribing audit; Hospitalised children.