Antimalarial Drug Prescribing Practice In Pediatrics In A University Teaching Hospital.

Objective: The study was carried out to describe the antimalarial drug prescribing practice in pediatrics in the University of Nigeria Teaching Hospital, Enugu. The specific objectives were to determine: the cases that were diagnosed based on laboratory investigation; the specific antimalarial drugs prescribed for the treatment of uncomplicated malaria cases between 2003-2011; the changes- if any- in the prescription pattern of the prescribers following the introduction of the Treatment Guidelines and the level of their compliance to the guidelines

Method: The patients’ medical charts were assessed. The exclusion criteria were patients with uncomplicated malaria below 6 months of age and above 5 years of age, and patients with special disease conditions like HIV. Inclusion criterion was patients with uncomplicated malaria between the ages of 6 months and 5 years. A total of 3034 prescriptions were collected for data extraction and analysis. With the use of a modified WHO prescribing indicator form, these data were collected; demographic data, clinical presentations (symptoms), laboratory investigation and the specific antimalarial drugs prescribed. Data were grouped into two; the pre-policy period (2003-2005) and the post-policy period (2006-2011), and then analysed using Excel spreadsheet and SPSS.14.0 software for descriptive and inferential statistics respectively. 

Results: The results of the study showed that the number of malaria cases that were diagnosed based on positive malaria parasite test were 4.8% of 2765 patients diagnosed of malaria.  Artemether-Lumefantrine combination was the most prescribed antimalarial drug with 45.4%. It was 2% of the prescriptions in the pre-policy period and 63.3% in the post-policy period. Although there was a significant increase in the prescription of ACT in the post-policy period (32.6%), the compliance to the Antimalarial treatment guideline (ATG) was low (23.8%).

Conclusion:  This study revealed an increase in the prescription of Artemisinin-based combination therapy after the introduction of the National Antimalarial Treatment Guideline. Nevertheless, prescribers did not adhere strictly to the guideline. Many of the Artemisinin-based combination therapy prescribed were not the recommended ones. There was a high incidence of empirical diagnosis/treatment of malaria as opposed to parasitological/confirmatory diagnosis/treatment. Among the WHO drug use indicators, there was still a lot of room for improvement in the prescription of drugs in generics by prescribers.