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Drug Use Evaluation of Crystalline 2020 Drug Use Evaluation of Crystalline Penicillin in Pediatrics Ward of Dessie Referral Hospital, North East Ethiopia: A Hospital Based Cross Sectional Study Taklo Simeneh Yazie1*, Ayalneh Gedif Tessema2 1Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. 2Data user officer at NGO funded by USAID, Ethiopia. Received: 2020-03-25, Revised: 2020-05-06, Accepted: 2020-05-06, Published: 2020-09-30 ARTICLE INFO ABSTRACT Article type: Background: Antibiotic resistance is a worldwide issue due to rise of antibiotic consumption and Original article wide variation in antibiotic prescribing practices. Crystalline penicillin is the most highly consumed Keywords: antibiotics by hospitalized pediatrics patients in Dessie Referral Hospital and its utilization pattern Penicillin G; is not known in the study area. The objective is to assess the appropriateness of crystalline penicillin Drug Utilization Review; use in pediatrics ward of Dessie Referral Hospital, Northeast Ethiopia. Drug Evaluation; Methods: A hospital based cross-sectional study was used for evaluating medication records of Dessie Referral Hospital; hospitalized pediatric patients who received crystalline penicillin from October to December 2018. World Health Organization Results: A total of 262 hospitalized pediatrics patient records were included in the study. All the 262 (100%) cases were consistent with guidelines for contraindication and drug interaction to use the drug. Crystalline penicillin use was consistent with guideline recommendations in 93.8%, 92.8%, 89.6%, 66.7% and 39.4% of the cases with regard to, indication, outcome, frequency, dose and duration of treatment, respectively. The observed value of all drug utilization evaluation parameters except drug interaction and contraindication showed statistically significant difference from the set threshold in nonparametric binomial test. Conclusion: The result of the current study especially with regard to dose and duration is much below the recommended threshold and needs scheduled trainings and necessary interventions to tackle the problem. J Pharm Care 2020; 8(3): 123-128. Please cite this paper as: Yazie TS, Tessema AG. Drug Use Evaluation of Crystalline Penicillin in Pediatrics Ward of Dessie Referral Hospital, North East Ethiopia: A Hospital Based Cross Sectional Study. J Pharm Care 2020; 8(3): 123-128. Introduction infectious diseases is threatened by the stable increase Drug use evaluation (DUE) is a system of ongoing, in the number of microorganisms that are resistant systematic criteria-based evaluation of drug use that to antimicrobial agents (4). Antibiotic resistance is a will help ensure that medicines are used properly at the worldwide issue due to rise of antibiotic consumption individual patient level (1). It is a comprehensive review and wide variation in antibiotic prescribing practices. of patients’ prescription and cards before, during and after The most common causes of irrational drug use are dispensing in order to assure right therapeutic decision inappropriate use of antimicrobials, overuse of injections making and positive outcome (2). A DUE can be structured when oral formulations are more appropriate, the use of to assess the real process of prescribing, dispensing too many medications per prescription, failure to adhere or administering a drug and it covers indications, dose, to guidelines while prescribing medications, inappropriate frequency, duration of treatment (3). self-medication (3, 5). Antimicrobials are used to decrease morbidity and Overuse of antibiotics can result in development of mortality from infectious diseases, but the control of newly resistant bacteria strains, raising costs of health *Corresponding Author: Mr Taklo Simeneh Yazie Address: Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. Email: [email protected] Drug Use Evaluation of Crystalline Penicillin services, prolonged hospitalization, development of side cases are reviewed and if there are fewer than 30 cases per effects and deaths (6). The adverse effect of misuse of quarter, then 100% of the cases are reviewed (10). Based antibiotics is more serious in children than adults (7). on these criteria, patient medication records containing In developing countries, it is evident that antibiotics are crystalline penicillin and targeting pediatric patients prescribed for 44 to 97% of hospitalized patients often was considered retrospectively for a quarter (October to unnecessarily (8). Empirical use of antibiotics is a common December 2018). practice in developing countries including Dessie Referral From the study which encompassed data of three-month Hospital (DRH) and there is no STG for referral hospitals. crystalline penicillin use in pediatric ward, the number of This can result in serious resistance problems unless it cases per quarter with crystalline penicillin indication was is studied periodically. Crystalline penicillin is the most found to be 524. Therefore, to obtain greater point estimate commonly used antibiotics in DRH of hospitalized of population, about 262(50%) medication records were pediatric patients. Antibiotic with a risk of abuse, high taken as the final sample size which is much greater consumption rate, and that was not being controlled by than the minimum sample size (n=30) as per JCAHCO antibiotic prescribing restriction system were the criteria recommendation. used for selection of crystalline penicillin in the present After the sample size had been determined for the study, study. To our knowledge, there is no adequate studies systematic random sampling was employed to obtain address crystalline penicillin use evaluation in Ethiopia sample population. Sampling frame was prepared by and there is no previous study in DRH. Therefore, coding 524 medication records according to date of conducting the present study is logical to assess crystalline r e c o r d s a n d s a m p l i n g i n t e r v a l w a s c a l c u l a t e d a s f o l l o w s : penicillin use and its appropriateness in accordance with K= Study population/ calculated sample size = 524/262 World Health Organization (WHO) DUE guideline (3), = 2 and WHO guideline for management of common illness Once the first sample was randomly selected, all the rest in pediatric patients in areas of limited resources (9). samples were taken by picking every 2nd of the medical The finding of this study provides information on status record until the required sample was obtained. of crystalline penicillin use which further helps to take Independent variables including: Patient characteristics: appropriate measure on that specific problem to prevent age, sex, weight and diagnosis. And dependent variables misuse of crystalline penicillin. including: Indication, Dose, Frequency, Duration of treatment, Contraindication, Drug interaction. Methods Patients’ medication records were used to collect data. The study was conducted from January to March 2019 Data collection format was developed based on WHO in hospitalized pediatric patients admitted from October to recommendation (3). Pretest was done on 10% of medical December 2018 in DRH. The hospital is located in Dessie records (27 medical records) to check the validity Town, Northeast Ethiopia, 401 km northeast of the capital and reliability of data collection format. The pretest city, Addis Ababa. Dessie Referral Hospital is the only sample size is within the range of different literature referral hospital in this part of the country, with catchment recommendations (11). The data were collected by 2 population of seven million. The hospital has 200 beds and senior clinical pharmacists. Drug use evaluation criteria 165 healthcare professionals. The pediatric wards have 52 with thresholds was set based on the WHO guide for DUE beds and 12 health professionals (2 general practitioners, 1 and WHO Guidelines for the management of common pediatrician and 9 nurses). illnesses in children in areas where limited resources are Ethical approval was obtained before the starting of the considered (3,9) or (see Table 1). study from the ethical review committee of college of medicine and health sciences, Wollo University. The The primary outcome measures were appropriateness management of the hospital was requested for cooperation of crystalline penicillin use with regard to the six DUE with a formal letter from Wollo University. During and after parameters and the secondary outcome measures were the data collection process all patient-related data were kept death, clinical improvement and switch to oral therapy. confidential. Finally, the collected data was analyzed using SPSS A hospital based retrospective cross sectional study was version 20. The non-parametric binomial test was used to used to evaluate utilization pattern of crystalline penicillin analyze the data and the p value of < 0.05 was considered in pediatric ward of DRH in the study period. statistically significant. According to the Joint Commission on Accreditation The inclusion criteria for this study was all hospitalized of Healthcare Organizations (JCAHCO) criteria which pediatric patients receiving crystalline penicillin in DRH mandates: if the average number of cases per quarter from October to December, 2018. Incomplete medical is more than 600, at least 5% cases are reviewed; if the records and medical records with underlying renal and number of cases per quarter is fewer than 600, at least 30 hepatic disease were excluded from the
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