An audit of antimicrobial treatment practices and laboratory diagnostics in febrile paediatric patients at Mzimba South District Hospital
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Date
2022-03-01
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Abstract
Background: It is a recommendation clinician to use Standard Treatment Guidelines (STG) to
come up with presumptive diagnosis or order laboratory tests to support the diagnosis.
Adherence to STG alone is a global concern.
Objective: This study was to evaluate the antimicrobial prescribing practices among febrile
paediatric patients in relation to Malawi Standard Treatment Guidelines (MSTG) and
laboratory findings or usage at Mzimba South District Hospital (MSDH).
Methods: This was a retrospective cross-sectional study using mixed methods where
quantitative and qualitative methods were employed. Three hundred and sixty case notes for
paediatric patients admitted to the children's ward from January to December 2017 were
assessed.
Findings: The common febrile illness diagnosed were malaria 194 (53.9%), sepsis 108(38.3%)
and pneumonia 99(27.5%). The use of MSTG and laboratory investigations in prescribing was
at 18.1% and 28.3% respectively. Despite the availability of MSTG and laboratory tests to
guide antimicrobial prescribing practices, Amoxicillin was prescribed in 90%, Benzylpenicillin
85%, and Gentamicin 69% of febrile ill patients regardless of the malaria positive test results
or the diagnosis. Artesunate and LA were prescribed in malaria negative patients in the final
diagnosis of malaria at 49 (38.1%), sepsis 44 (40.7%) and pneumonia 19 (19.9 %).
Conclusion: The laboratory tests and MSTG had minimal support to antimicrobial prescribing
practices at MSDH. Prescribers prefer the use of empirical treatment with a focus on broad
spectrums and if in dilemma consult the seniors. We recommend establishment of
antimicrobial stewardships to monitor antimicrobial use and advocate on MSTG use.
Furthermore, we recommend strengthening microbiology facilities to support identification of
microbe and antimicrobial susceptibility.