P260 Inadequate antibiotic prescription in paediatric gastroenteritis – medical and non-medical causes

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Abstract

Backgroud and Aim

Antibiotics have produced an estimated increase of life-expectancy of 2 to 10 years. Due to irrational use of antibiotics, bacteria gained multi-resistance. 23.000 patients die each year in US due to infections with resistant bacteria. The aim of our paper is to describe controllable mechanisms of antibiotic excessive prescription for acute gastroenteritis (AGE) in a tertiary referral paediatric hospital.

Material and Methods

Five months prospective study regarding all ICD 10 A00-A09 (Intestinal infectious diseases) discharged patients and a subgroup of outpatients treated in Emergency Department. Children up to 5 years with no significant comorbid conditions or immune-deficiency were included. Parents of ED-treated children received a questionnaire to evaluate before discharge a subset of expectancies related to hospital care.

Results

250 [191 inpatients and 59 outpatients] were included and 211 [84.4%] had a documented cause for acute gastroenteritis. 42.8% rotavirus and 18.4% Campylobacter cases were diagnosed. 24.4% presented multiple etiologies, roto-adenovirus representing the most frequent in 29.5% of coinfections. More than half (51.5%) of virus-induced AGE were treated with antibiotics.

Discussions

Subgroup analysis was performed and a pattern of prescription was described. Inpatients, infants, children with more severe dehydration [CDS above 4], those presented during weekend and parental expectation for antibiotic treatment were risk-factors for inappropriate antibiotic prescription. There were significant fewer antibiotic prescriptions in ED-treated patients compared with inpatients of similar severity or age group.

Conclusion

Antibiotic stewardship programs should be implemented and behaviour patterns, both of parents and physicians, should be changed in order to decrease antibiotic-overuse in children.

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