An audit of antimicrobial treatment practices and laboratory diagnostics in febrile paediatric patients at Mzimba South District Hospital

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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.