https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/124 Mon, 31 Oct 2016 11:56:29 +0000 Ibrahim Med. Coll. J. 2008; 2(2): 61-64 Key Words: Antimicrobial therapy, cost differentials, pneumonia, diarrhoea. Pneumonia and diarrhoea are two major paediatric health problems in developing countries including Bangladesh.1-3 It has been calculated that the average individual ingests about 8 microorganisms per minute or 10,000 per day.4 The respiratory and gastro intestinal tracts are the most common sites for infection by pathogens, often requiring antimicrobial therapy. The World Health Organization estimates that up to 40% of the total health care cost in developing countries may be for drugs.5  Several studies in developing countries such as India, Thailand and Tanzania estimate that from 24 to 50% of the total pharmaceutical budget are spent on antimicrobial agents in these countries.6-8 This study was conducted in the paediatric wards of two randomly selected medical college hospitals in Bangladesh - one public and another private. The data collection procedure was prospective in nature. The treatment charts of 107 admitted paediatric patients who received antimicrobial agent(s) for the treatment of pneumonia (88) or diarrhoea (19) were reviewed daily from the day of admission of the patients till their discharge. There were 18 pneumonia patients in the public and 70 in the private hospital. These figure were 7 and 12 respectively for the diarrahoea cases. The total cost of antimicrobial agents per patient was based on the current market price of these agents. Estimation of the cost per patient: CTiAM = å (Unit price of each antimicrobial agent ´ ‘quantity used per day’ ´ duration of hospital treatment). The calculated total cost was determined by summing up costs of all antimicrobial agents given to individual patients.   Results Table-1: Distribution of antimicrobial agents used for the treatment of pneumonia (*n = 127) Medical College Hospitals Private No.(%) Amoxicillin 40 (38.46) Gentamicin 40 (38.46) Ceftriaxone 8  (7.69) Cephradine 10  (9.62) Ceftazidime 6  (5.77) Total 104 (100)   *n=number of courses of commonest five antimicrobial agents.   Table-2: Distribution of antimicrobial agents used for the treatment of diarrhoea (*n = 14) Medical College Hospitals Private No.(%) Ceftriaxone 2 (22.22) Cephradine 2 (22.22) Amoxicillin 2 (22.22) Metronidazole 1 (11.12) Ampicillin 2 (22.22) Total 9   (100)   Pneumonia:Diarrhoea: The average cost of antimicrobial agents per patient suffering from diarrhoea was Taka 221.45 across the hospitals while it was Taka 199.31 and Taka 279.00 in private and public hospital respectively (Table-3).   Table-3: Average costs of antimicrobials used for the treatment of admitted paediatiric patients     Table 3 shows that the average costs of antimicrobial agents used for both pneumonia and diarrhoea varied among hospitals. The average costs for antimicrobial treatment of pneumonia were far greater in the private hospital. The average cost of antimicrobial treatment of diarrhoea was surprisingly higher in the public hospital.   Discussion In both conditions, there was a great potential for saving hospitals’ and patients’ treatment cost if appropriate intervention(s) are made and/or strategies improved for antimicrobial prescribing practices in hospitals of Bangladesh. 1.     Liss RH, Batchelor RF. Economic evaluations of antibiotic use and resistance—a perspective: report of Task Force 6. Reviews of Infectious Diseases 1987; 9 (supplement 3): S297–S312. 3.     Kunin CM, Lipton HL, Tupasi T, Sacks T, Scheckler WE, Jivani A, et al. Social, behavioural, and practical factors affecting antibiotic use worldwide: report of Task Force 4. Reviews of Infectious Diseases 1987; 9 (supplement 3): S270–S285. 5.     Kunin CM. In comment. Journal of the American Medical Association 1974; 227: 1030–1032. 7.     Anonymous. Drug use in the Third World [letter]. Lancet 1980; 1: 1231–1232. 9.     Kabir AL, Kawser CG, Shohidullah M, Hassan MQ, Talukder MQK. Situation analysis of child health in Bangladesh. Bangladesh Journal of Child Health 1994; 19(2): 63–68. 11.  Ali L, Choudhury SAR. Study of drug utilization pattern at a teaching hospital. Bangladesh Journal of Physiology and Pharmacology 1993; 9: 27–28. 13.   Choudhury AKA, Hossain MH, Bhuiya MDH, Islam MA. A study report on prescribing pattern in diarrhoeal disease in three districts of Bangladesh. Unpublished, 1991; 7. 15.   Sultan-Ul-Alam M, Barua PC, Rashid DMH, Islam AFMS. A survey of the pattern of drug utilization for watery diarrhoea at Primary Health Care level of Chittagong division. Hygeia 1993; 7(1): 15–18. 17.   Choudhury AKA, Khan OF, Matin A, Haque Z, Bhuiya AL. Impact of standard treatment guidelines and small group training on prescribing for diarrhoea in under five children in Thana Health Complexes in Bangladesh. International Conference on Improving Use of Medicines, April 1-4, 1997; Chiang Mai, Thailand. 2026 Ibrahim Medical College. All rights reserved.