Patterns of antibiotic prescription during febrile episodes in pediatric patients with cancer at the Kenyatta National Hospital.

Abstract

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.