Antibiotic Prescribing Pattern in Neonates of Seventeen Iranian Hospitals

Background: The association between the use of antibiotics and bacterial resistance has obviously been established and it seems to be a significant problem for public health. It is clear that irrational use and high rates of antibiotic prescription are associated with increased bacterial resistance. As antibiotics are the class of drugs commonly prescribed in neonatal and Neonatal Intensive Care Unit (NICU) wards, neonates are at high risk of opportunistic or nosocomial infections due to prolonged hospitalization and immunosuppressed condition. Objectives: It is essential for antibiotic prescription patterns to be evaluated periodically for rational use. Therefore, the present study was carried out to identify the prescribing patterns of antibiotics in neonatal and NICU wards of 17 different Iranian hospitals. Methods: The study was done during 1 calendar week between January and February 2014. All in-patients admitted to the NICU and neonatal units of 17 Hospitals in 15 Iranian cities were included. Relevant data of all neonates receiving an antibiotic at 8 am on the day of the study was collected by trained members of the study team; age of the patients, type and number of administered antibiotics, route of administration, underlying disease, and indication for use were documented. Results: The total number of neonatal in-patients was 366 on the day of the study. Mean age of infants was 9.2 ± 3.9 days, with 54.4% being male. Overall, 264 patients (72.1%) were being given one or more antimicrobials; the proportion of patients receiving antibiotics ranged from 21.4% to 100% in different neonatal units. Most frequent antibiotics used were ampicillin (25.6%), vancomycin (16.4%), amikacin (10.6%), and cefotaxime (9.74%). Parenteral route was used in 255 cases, (96.6%); 110 (41.7%) antibiotic courses were prescribed for community-acquired infections, 29 (11 %) for hospital-acquired infections, 42 (15.9 %) for pre- or post-operative prophylaxis, and 83 (31.4 %) for medical prophylaxis. Empirical antibiotics were administered to 255 newborns (96.6 %); 96.2% of patients received combination therapy. Conclusions: High use of empirical and prophylactic antibiotics, overuse of vancomycin and third generation cephalosporins are of concern and contrary to recommended therapies. Therefore, guidelines for the use of antibiotics in neonates are required and a larger number of studies are needed.