Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, South Western Nigeria

Background: Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. Objectives: To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use. Method: Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. Results: Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. Conclusion: Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.