Patterns of antibiotic prescription during febrile episodes in pediatric patients with cancer at the Kenyatta National Hospital.
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Date
2020Author
Muchela, Maureen A
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Background: Children with cancer have increased vulnerability to infections. Prompt
initiation of empiric antibiotics for fever episodes as guided by local antimicrobial sensitivity
patterns is therefore recommended. However, irrational use of antibiotics, has been
demonstrated even in the presence of clinical guidelines. This study aims to describe the
patterns of antibiotic prescription during febrile episodes among pediatric oncology patients
at the Kenyatta National Hospital (KNH).
Objectives: To describe the antibiotic prescription patterns during febrile episodes in children
1-15 years of age with suspected or confirmed cancer, to describe the clinical and laboratory
evaluation of febrile illness in children with cancer at the KNH.
Methodology: A retrospective study was done. Paediatric patients with cancer and febrile
episodes in KNH fulfilling the inclusion criteria were recruited into the study and data
collected for the most recent febrile episode from October 2018 to September 2019.
Data analysis: Descriptive statistics were performed to generate frequencies, percentages,
means and medians. Inferential statistics was conducted through the Chi-Square test of
independence as well as binary logistics regression. Analysis was done using IBM SPSS
Version 25.
Results: 139 most recent febrile episodes were included. Median age was 6 years (IQR 3-
9years), 58.3% were males, and the most common underlying malignancies were solid
tumors in 43.7%, and 64.4% of the study participants had received chemotherapy. Nonneutropenic febrile episodes were predominant (69.4%), febrile neutropenic episodes
consisted 30.6%. Mean temperature was 38.50C (±0.670C), mean duration of febrile episode
was 5days (±3 days), median length of admission prior to the febrile episodes was 28 days
(IQR 6-75 days).
Antibiotics were prescribed in 86.2% of the febrile episodes. A significant association was
noted between the type of febrile episode and the antibiotic therapy prescribed, X2 (p=0.017)
with antibiotic monotherapy prescription more likely for non-neutropenic febrile episodes
while combination antibiotics more likely for neutropenic episodes. Antibiotic combination
prescription containing 3rd generation cephalosporins was most frequent in neutropenic
febrile episodes (33.3%) and antibiotic monotherapy prescription containing 3rd generation
cephalosporins was the most frequent (54.8%) for non-neutropenic febrile episodes. Mean
antibiotic duration was 9days (SD 5 days) and in 42.4% of the febrile episodes had recent
antibiotic use, with a higher proportion among neutropenic febrile episodes.
Conclusion:
There is a varied pattern of antibiotic prescription for both neutropenic and non neutropenic
fever episodes, with 3rd generation- cephalosporin- based-combination therapy most
frequently prescribed for neutropenic febrile episodes, and ceftriaxone monotherapy most
frequently prescribed for non neutropenic febrile episodes.
Recommendations;
We recommend developing local clinical practice guidelines for the management of febrile
non neutropenic episodes in pediatric oncology patients and judicious antibiotics use for
febrile episodes in paediatric oncology patients at the KNH.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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