Evaluation of antibiotics in pediatrics using the defined daily doses method and the World Health Organization (WHO) access, watch, and reserve classification (AWaRe 2021): a cross-sectional study.

Abstract

Introduction: irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021).

Methods: this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s "AWaRe" categorization: "Access," "Watch," and "Reserve."

Results: a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively.

Conclusion: antibiotic use was high in the research setting. Over half of the antibiotic use was in the "Watch" group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.