Antimicrobial prescribing patterns among pediatric outpatient encounters in primary healthcare centers in Bujumbura Mairie, Burundi.

Abstract

Background: Understanding prescribing patterns is essential for developing targeted interventions to promote rational antimicrobial use. This study evaluated antimicrobial prescribing patterns among pediatric outpatients at primary healthcare centers (PHCs) in Bujumbura Mairie, republic of Burundi.

Methods: We conducted a cross-sectional study at 20 PHCs in Bujumbura Mairie, Republic of Burundi, to evaluate antimicrobial prescribing patterns. We collected retrospectively 2022-year data from medical records using the World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) core drug indicators. According to these WHO guidelines, a minimum sample size of 600 prescriptions is recommended to assess drug use indicators. To meet this requirement, a total of 800 paediatric outpatient prescriptions were sampled. Prescriptions for inpatients were excluded.

Results: A total of 497 (62.1%) out of 800 prescriptions contained antimicrobials, far exceeding WHO recommendations (20-26.8%). Younger patients, particularly children under five, received the highest proportion of antimicrobial prescriptions (15.6%). Although generic prescribing (95.0%) and adherence to the National Essential Medicine Lists (NEML) (95.8%) were high, they fell short of WHO benchmarks (100%). Most prescriptions followed monotherapy (92.8%) with a low average of 1.1 antimicrobials per prescription (WHO guidelines 1.6-1.8). Although Access-group dominated (71.3%), Watch-group usage (25.3%) surpassed the recommended threshold (< 20%), and WHO non-recommended fixed-dose combinations were also prescribed (3.4%). In addition, 26.2% of prescriptions lacked documented indications.

Conclusion: The present study highlights strong adherence to essential medicine lists and generic antimicrobial use. However, findings also reveal areas for improvement, including the need for documentation of indication and reduction of utilization of Watch group antibiotic use. To optimize antimicrobial use and prevent AMR in Burundi's paediatric population, further national research, healthcare worker training, diagnostics, and antimicrobial stewardship implementation are necessary.