Antibiotic-Prescribing Practices for Management of Childhood Diarrhea in 3 Sub-Saharan African Countries: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study, 2015-2018.

Abstract

BACKGROUND:

Despite antibiotic prescription being recommended for dysentery and suspected cholera only, diarrhea still triggers unwarranted antibiotic prescription. We evaluated antibiotic-prescribing practices and their predictors among children aged 2-59 months in the Vaccine Impact on Diarrhea in Africa (VIDA) Study performed in The Gambia, Mali, and Kenya.

METHODS:

VIDA was a prospective case-control study (May 2015-July 2018) among children presenting for care with moderate-to-severe diarrhea (MSD). We defined inappropriate antibiotic use as prescription or use of antibiotics when not indicated by World Health Organization (WHO) guidelines. We used logistic regression to assess factors associated with antibiotic prescription for MSD cases who had no indication for an antibiotic, at each site.

RESULTS:

VIDA enrolled 4840 cases. Among 1757 (36.3%) who had no apparent indication for antibiotic treatment, 1358 (77.3%) were prescribed antibiotics. In The Gambia, children who presented with a cough (adjusted odds ratio [aOR]: 2.05; 95% confidence interval [95% CI]: 1.21-3.48) were more likely to be prescribed an antibiotic. In Mali, those who presented with dry mouth (aOR: 3.16; 95% CI: 1.02-9.73) were more likely to be prescribed antibiotics. In Kenya, those who presented with a cough (aOR: 2.18; 95% CI: 1.01-4.70), decreased skin turgor (aOR: 2.06; 95% CI: 1.02-4.16), and were very thirsty (aOR: 4.15; 95% CI: 1.78-9.68) were more likely to be prescribed antibiotics.

CONCLUSIONS:

Antibiotic prescription was associated with signs and symptoms inconsistent with WHO guidelines, suggesting the need for antibiotic stewardship and clinician awareness of diarrhea case-management recommendations in these settings.

• Authors: Alex O Awuor, Billy Ogwel, Helen Powell, Jennifer R Verani, Samba O Sow, M Jahangir Hossain, John B Ochieng, Jane Juma, Leslie P Jamka, Anna Roose, Sanogo Doh, Emily L Deichsel, Uma Onwuchekwa, Adama Mamby Keita, Martin Antonio, Joquina Chiquita M Jones, Syed M A Zaman, Henry Badji, Irene N Kasumba, Dilruba Nasrin, James A Platts-Mills, Eric R Houpt, David M Berendes, Ciara E Sugerman, Marc-Alain Widdowson, Sharon M Tennant, Eric D Mintz, Richard Omore, Karen L Kotloff
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 76 Issue 76 Suppl1 Pg. S32-S40 (04 19 2023) ISSN: 1537-6591 [Electronic] United States
• PMID: 37074427 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Chemical References

• Anti-Bacterial Agents
• Vaccines

Topics

• Child
• Humans
• Anti-Bacterial Agents (therapeutic use)
• Case-Control Studies
• Cough (drug therapy)
• Diarrhea (drug therapy, epidemiology)
• Kenya
• Vaccines