Rational use of antimicrobials in infants in primary care of Bahrain

Abstract

This nationwide prescription-based study was undertaken to evaluate antimicrobial prescribing for infants, and to identify prescribing errors in infants in 20 primary care health centres of Bahrain. Data was collected on a daily basis by pharmacists in May 2004. Antimicrobials ranked the 5th most common drugs prescribed in infants; beta-lactams, notably amoxycillin and cephalexin, comprised 81.6% of overall prescribed antimicrobials. Antimicrobials were prescribed to approximately one out of four infants (23.8%), prescribed more often to infants aged 9-12 months of age. Approximately one-fifth (22%) of infants received antimicrobials at subtherapeutic daily doses. The prescribing errors were related to dosage (39.2%), strength/doses (26.4%), frequency of dosing (19.2%), and duration of therapy (4.5%). Antimicrobial dosage prescribed in relation to infants' age revealed a positive correlation for amoxycillin (r = 0.264; p < 0.0001), cephalexin (r = 0.223; p = 0.029), erythromycin (r = 0.127; p = 0.284), and a negative correlation for metronidazole (r = -0.183; p = 0.415). Overt use of antimicrobials in infants, and prescription-writing errors (in dosages and frequency of dosing) were common in primary care. Dosage adjustment in relation to developmental stages of infants has received inadequate attention. Effective strategies to improve prescription writing skills are urgently required.