





































Clinical Medicine Insights.
Received 5 May 2021 | Revised 10 June 2021 | Accepted 15 July 2021 | Published Online 27 July 2021

DOI: https://doi.org/xx.xxx/xxx.xx 
CMI 2 (3), 150−154 (2021) ISSN (O) 2694-4626 

RESEARCH ARTICLE

Trend And Pattern Of Antibiotic Practice In Paediatric Surgery In 
Bangladesh

Mohammad Mahabubul Alam1 Mohammad Saiful Islam2 Shamsuzzaman Khan3 Mafia
Afsin Laz4
1Assistant Professor, Department
of Pediatric Surgery, Cumilla
Medical College, Cumilla,
Bangladesh

2Professor, Department of
Pediatric Surgery, Bangabondhu
Sheikh Mujib Medical University,
Dhaka, Bangladesh

3Assistant Professor, Department
of Pediatric Surgery, Shaheed
Suhrawardi Medical College,
Dhaka, Bangladesh

4Assistant Professor, Department
of Pediatric Surgery, Sir
Salimullah Medical College &
Mitford Hospital, Dhaka,
Bangladesh

Abstract
Introduction: Antibiotics are frequently over prescribed, misused or 
inappropriately used both in developed or developing countries. The 
extent and pattern of inappropriate use is well documented in devel-
oped countries but such studies are few in developing countries like 
Bangladesh. Objective: To find out trend and pattern of antibiotic 
practice in paediatric surgery in Bangladesh Methodology: This cross 
sectional descriptive study was carried out on 260 paediatric patients of 
0-15 years age range, to find out the pattern of antibiotic practice in pe-
diatric practicing hospital and different clinic of Cumilla, Bangladesh. 
All the patients were studied after categorization into i) Clean ii) Clean-
contaminated iii) Contaminated and iv) Dirty wounds according to 
their potentiality of post-operative wound infection. Total period of 
antibiotic practice was divided into a. Pre-operative (Up to the day 
before operation) b. Per-operative (during or just before operation) c. 
Post-operative (days after operation) and d. Post-discharge stage for the 
convenience of this study. Antibiotic practice in all categories during 
all periods mentioned were compared and evaluated. Results: More 
than two antibiotics were given in a single patient in 48.1% of clean 
and 51.9% of contaminated patients in a combination or sequentially. 
More than 3 antibiotics were used in a single patient. On the average 
total number (mean) of antibiotic use was more than two (2.64 +1.09). 
The highest number (mean) of antibiotics was used in contaminated 
category (3.29) with range of (0-7). Overall total duration (mean) of 
antibiotic used was 17.40 days.
Keywords: Antibiotic practice, Paediatric surgery, preoperative, Post-
operative 

Copyright : © 2021 The Authors. Published by Medical Editor and
Educational Research Publishers Ltd. This is an open access article
under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

CMI 2 (3), 150−154 MEERP LTD 150

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1 INTRODUCTION

Antibiotics are frequently over prescribed,
misused or inappropriately used both in de-
veloped or developing countries1. This is

not only unnecessary and wastes of resources but
also increases the risk of adverse clinical conse-
quences in a situation where objective benefits are
doubtful2. Studies conducted in general and teaching
hospitals showed that about 28% of our patients and
52%of the inpatient of a general hospital and 60.36%
of the patients in a teaching hospital received antibi-
otic therapy that was not appropriate3. Irrational use
of antibiotic was also wide spread seen in several
studies conducted in China4,5, Indonesia and Sudan6
and Thailand.7 Antibiotic misuse is also commonly
seen at discharge after operation. This abuse of
antibiotic prophylaxis leads to excessive surgical
wound infection rates and strongly contributes to the
emergence of bacterial resistance8. The number of
this antibiotic resistance strains has been correlated
with the number of kilograms of antibiotic used in
any given hospital. The cost of such irrational drugs
is enormous in terms of our scarce resources9.It has
been observed that even after obtaining adequate
asepsis surgical site infections are still one of the
most important causes of postoperative morbidity
and mortality10. Antibiotics have a key role to play
in minimizing these unwanted consequences11. The
risk of postoperative wound infection has been re-
ported to a range from 0% to 40% depending upon
the surgical procedure performed. Most surgeons
tend to use antibiotic in almost all cases of surgery
irrespective of their categories in order to have an
infection free record12. Common errors in antibiotic
prophylaxis includes selection of wrong antibiotic,
administering first dose too early or too late of mak-
ing incision, failure to repeat doses during prolong
procedures, excessive duration of prophylaxis and
inappropriate use of broad spectrum agents. The rea-
sons behind this over use may be lack of confidence
regarding sterilization status of operation theatre and
instruments, inadequate information about sensitiv-
ity pattern of local infecting agents, over reliance
on newer antibiotics, preference of daily dosing
to multiple dosing, affluent patients preference of
costly drugs and above all aggressive sales promo-

tion by pharmaceutical companies13. Although the
extent and pattern of inappropriate antibiotic uses are
extensively documented in the developed world14,
such types of studies are now few and limited in
developing countries like Bangladesh. This study
will therefore be undertaken to find out the extent and
pattern of antibiotic use in our paediatric surgery to
identify the prescribing trend to emphasize the issue
of rational usage.

2 METHODOLOGY

This cross sectional descriptive study was carried out
on 260 paediatric patients of 0-15 years age range, to
find out the pattern of antibiotic practice in pediatric
practicing hospital and different clinic of Cumilla,
Bangladesh. All the patients were studied after cate-
gorization into i) Clean ii) Clean-contaminated iii)
Contaminated and iv) Dirty wounds according to
their potentiality of post-operative wound infection.
Total period of antibiotic practice was divided into
a. Pre-operative (Up to the day before operation)
b. Per-operative (during or just before operation) c.
Post-operative (days after operation) and d. Post-
discharge stage for the convenience of this study.
Antibiotic practice in all categories during all periods
mentioned were compared and evaluated.
Table 1: Classification of Surgical wounds.

Supplementary information The online version of
this article (https://doi.org/xx.xxx/xxx.xx) contains
supplementary material, which is available to autho-
rized users.

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ALAM ET AL.

3 RESULTS

On the average total number (mean) of antibiotic use
was more than two (2.64 +1.09). The highest number
(mean) of antibiotics was used in contaminated cat-
egory (3.29) with range of (0-7). The lowest num-
ber of antibiotics was used in clean category (2.19
SD+1.06) (Table-2). The difference in the number
of total antibiotics used is not significant (P>.05) be-
tween clean-contaminated and dirty category. Over-
all total duration (mean) of antibiotic used was 17.40
days. The duration of total antibiotic used in clean
and dirty categories was around 16 days. Maximum
total duration (20 days) of antibiotic use was found in
clean-contaminated category (Table-3). The differ-
ence between Group A, Group C and Group D was
not significant revealed byANOVA (P>.05ns).Mean
duration of postoperative antibiotics use was found
highest in clean-contaminated category (15.07 days),
lowest in dirty category (12.75 days). The duration is
significantly higher in group A, group B and group
C than group D revealed by ANOVA test.
Table 2: Total number of antibiotic used in each
patient (N=260)

FIGURE 2:

Table 3: Frequency of use of antibiotic at different
stages (N=260)

FIGURE 3:

Overall 68.0% patient received pre-operative an-
tibiotics. Minimum (49.6%) use seen in clean and
maximum (76.6%) in dirty category. On the average

79.6% patients received per-operative antibiotics.
Maximum (74.4%) per-operative use was seen in
clean and minimum (40.0%) in dirty category. Over-
all 95.7% of patients received post-operative antibi-
otics including all the patients of clean-contaminated
category. More than 80% patients in each group re-
ceived antibiotic after discharge. No significant dif-
ference is found in postoperative and post-discharge
antibiotics use among the groups (P>0.1ns).

4 DISCUSSION

This high frequency of pre-operative antibiotic usage
was perhaps due to prolonged pre-operative hospital
stay. Antibiotic prophylaxis has been extensively
substantiated by controlled clinical trials15. Never-
theless much concern has been voiced in the last few
decades about indiscriminate use of antimicrobials,
including broad-spectrum agents threatening emer-
gence of multiple drug resistance16. It was appre-
hended that indiscriminate use is ubiquitous, as such
is also prevalent in our working situation. This trend
of antibiotic use increases the risk of drug reaction
but also diminishes their effectiveness, promote drug
resistance and increases the overall treatment cost
17. The total duration of antibiotic usage during pre
and postoperative periods was found unduly pro-
longed (17.4 days) and had no significant difference
in between clean and clean contaminated categories
of wounds18 had also observed prolonged postop-
erative antibiotic use where most of the antibiotics
were given for more than five days. Postoperative
antibiotics were also found to be used for prolong
period (13 days) which exceeds the recommended
limit of surgical prophylaxis of (24-48 hours) after
operation15,19. It has been found that the critical
period of antibiotic action for effective postoperative
bacterial killing in clean or contaminated operation
was up to 36 hours of operation20 and prolong post-
operative antibiotic use has no added advantage or
therapeutic benefit 17,21. It was found that most of the
patients (98%) belonging to all categories received
antibiotics at least at one of four stages of treatment
irrespective of their nature of surgical disease and
category of wounds. Such practice of generalized
use of antibiotic has no rational basis as it has been

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“TREND AND PATTERN OF ANTIBIOTIC PRACTICE IN PAEDIATRIC SURGERY IN
BANGLADESH”
observed in studies that antibiotics were generally
not needed in “clean surgery” at any stage of treat-
ment 22,23 if not indicated otherwise. It was also
found that about two thirds (66.5%) of all patients
including about half (50.0%) of those in the clean
wound category received pre-operative antibiotics.
However it has been found that the length of preop-
erative hospital stay is not associated with increased
risk of post-operative wound infection 24. Almost
all patients received post-operative antibiotics and
virtually no significant difference was observed in
the frequency of antibiotic usage between different
categories of the patients in respect to the nature
of wounds. All of the prophylactic antibiotic usage
was continued beyond 48 hours of operation. The
period of continuance after the recommended 48
hours 25was also much higher than the finding of
Kass18 where he observed 65% of antibiotic prophy-
laxis was exceeded this limit in comparison to this
study where the limit was exceeded by 100%. The
trend of antibiotic usage after discharge in respect to
the frequency and duration of their use was found
similar in the different categories of surgical wounds
and virtually had no significant difference between
clean and dirty category. The practice of antibiotic
termination also appeared similar among different

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groups. Antibiotic use was found generous in all
the patients of surgical diseases irrespective of their
surgical wound categories. No distinct pattern of
choice of antibiotic was used in different categories
of patients. Postoperative antibiotics were used in a
similar frequency in all the categories. Antibiotic use
was continued for more than 48 hours after operation
in all categories of surgical illness. Present trend of
antibiotic practice in Paediatric Surgery.

5 CONCLUSION

Antibiotic overuse is generalized and not categorized
according to the categories of surgical wounds. A
consensus and collaborated effort is crucial to min-
imize this widespread indiscriminate antibiotic use.

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Antibiotic Practice In Paediatric Surgery In 
Bangladesh”. Clinical Medicine Insights.. 
2021;150−154. https://doi.org/xx.xxx/xxx.xx

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	Introduction
	Methodology
	Results
	Discussion
	Conclusion
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