Prescription of Antibiotics for Upper Respiratory Infections in Under-Five Children in an Indian Rural Health Centre: A Record Based Study

Development of drug resistance among bacteria is the result of over-use of antibiotics. Regarding upper respiratory infections (URI), in most cases, antibiotics are non effective in reducing the symptoms' length or strength. These issues being known, there are still evidences of over-use of antibiotics.The study was intended to assess antibiotic prescription in URI among under five children in the RHC of Ramanathapuram. The other objective was to identify factors influencing this prescription.A record based study was conducted by systematically reviewing all the under-five patients' records from RHC, JIPMER, Ramanathapuram in Puducherry. The data on symptoms, diagnosis and treatment of respiratory infections was collected for a period of one year from 01.12.2009 to 30.11.2010.

We found 692 visits regarding 250 children in patients' records, among which 21 were for lower respiratory infection and the other 671 for URI. Antibiotics were given 115 times (17%) among these 671 consults. Significant association between presence of fever and antibiotic prescription was found (OR = 4.32; CI = 1.27 14.71), as well as between a duration of symptoms greater than 3 days and antibiotic prescription (OR = 5.54; CI 95% = 2.16 14.24). Children brought for immunization were five time less likely to get antibiotics than others (OR = 0.20; CI = 0.08 0.46).We observed an inappropriate prescription of antibiotics in almost 20% of cases of URI, this prescription being based on presence of symptoms that are not validated criteria. This rate could be improved.