Journal of Tropical Pediatrics Advance Access published April 24, 2013

JOURNAL OF TROPICAL PEDIATRICS, 2013

Brief report

Use and/or Misuse of Antibiotics in Management of Diarrhea

Among Children in Enugu, Southeast Nigeria
by Uchenna Ekwochi,1 Josephat M. Chinawa,2,3 Ikechukwu Obi,2,3 Herbert A. Obu,2,3 and Samuel Agwu3
1
Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria
2
Department of Pediatrics, University of Nigeria, Enugu Campus, Ituku Ozalla, Enugu, Nigeria
3
Department of Pediatrics, Enugu State University of Science and Technology

Summary
Background: Diarrheal diseases are a leading cause of under-5 morbidity and mortality worldwide.
Objective: To determine the use and/or misuse of antibiotics on children with diarrheal disease
by caregivers.
Method: An observational prospective study involving 210 children and their caregivers seen at the
pediatric outpatient clinic of a tertiary hospital between January and May 2012 was undertaken.
Results: The mean age of the children was 18.07  14.29 months. One hundred twenty-four (59%) were
male, whereas 86 (41%) were female. Almost half of the children (46.7%) used unprescribed antibiotics
during an episode of diarrhea.
Conclusions: Antibiotics are being abused in children with diarrhea and caregivers need to be educated
against this urgently.
Key words: antibiotics, diarrhea, children.

Introduction
Diarrheal diseases are a leading cause of infant and
under-5 morbidity and mortality worldwide, with
estimated 1.8 million deaths each year, accounting
for 17% of childhood deaths [1, 2].
In Nigeria, antibiotics are the most widely used
drugs not only in treatment of diarrhea but other
infections [3].
Methodology
This is a prospective observational study that was
carried out at the Enugu State University Teaching
Hospital, Enugu. A structured self-administered
questionnaire was used to collect information
from the caregivers of children. Antibiotic misuse,
also called antibiotic abuse or antibiotic overuse,
was defined as the inappropriate use of antibiotics
without doctors prescription, with potentially
serious effects on health [4].
Data analysis
Data were analyzed using SPSS version 19.

Ethical considerations
These were sought from the Ethics and Research
Committee of the Enugu State University Teaching
Hospital, Enugu.
Objectives
To determine the use and or misuse of antibiotics
administration to children with diarrheal disease by
caregivers and associated factors.
Results
A total of 210 children aged 5 years and their caregivers participated in this study. The mean age of the
children was 18.07  14.29 months. One hundred
twenty-four (59%) were male, whereas 86 (41%)
were female, giving a male-to-female ratio of 1.4:1
Antibiotics use, reasons for giving antibiotics and
duration of treatment with antibiotics
As shown in Table 1, of the 210 subjects, about half
of the children 98 (46.7%) were given unprescribed
antibiotics during an episode of diarrhea. Other

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doi:10.1093/tropej/fmt016

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Correspondence: Uchenna Ekwochi, Department of Pediatrics, Enugu State University of Science and Technology Teaching
Hospital, Enugu, Nigeria. E-mail <uekwochi@yahoo.co.uk>.

BRIEF REPORT

TABLE 1
General features of caregiver respondents

TABLE 3
Duration of treatment

Frequency Percentage
n 210

TABLE 2
Reasons for giving antibiotics

55.1
40.8
4.1

TABLE 4
Indicating the type of unprescribed antibiotics used for
episodes of diarrhea
Frequency n 98

Percent

70
7
3
11
4
1
2

71.4
7.1
3.1
11.2
4.1
1.0
2.1

Metronidazole (Flagyl)
Amoxil
Septrin
Flagyl/Amoxil
Flagyl/Septrin
Amoxil/Septrin
Others

TABLE 5
Educational level and abuse or non-abuse of antibiotics

28

28.6

1
31
22
1
1
3

1.0
31.6
22.4
1.0
1.0
3.1

2
2

2.0
2.0

2.0

5.1

features are as shown in Table 2. Still other features

are shown in Tables 35.
Discussion
This study sought to describe the pattern of antibiotics use and/or misuse in children with diarrhea and
factors influencing its use. This study showed that
almost half of the caregivers administered antibiotics
to their children without doctors prescription. This is
similar to that seen in some series [5, 6]. The reason
for this ranges from indiscriminate use of antibiotics
in management of diarrhea to ignorance among caregivers on diarrheal illnesses.
2 of 3

54
40
4

14 days
57 days
>7 days

Frequency Percent
n 98
Available over-the-counter
without prescription
Cheaper
Efficacious
Neighbors suggestion
Neighbors suggestion efficacious
Neighbors suggestion cheaper
Neighbors suggestion available
over-the-counter
Efficacious/cheaper
Available over-the-counter
and efficacious
Available over-the-counter
and cheaper
Others

Percent

No antibiotic
n 112
None
FLSC
SSCE
Tertiary

0
12
38
62

(0.0)
(10.7)
(33.9)
(55.4)

Gave antibiotic
n 98
1
18
45
34

(1.0)
(18.4)
(45.9)
(34.7)

Chi-square 10.068, p 0.018.

It is important to note, in this study, that metronidazole and amoxil are the commonest drugs used
by caregivers to treat diarrhea without doctors prescription. The relatively low cost of these drugs and
their easy access over-the-counter make them seem
an attractive proposition to caregivers.
It was observed that most of the antibiotics administered to the children in this study were self-prescribed and bought over-the-counter, with a
possible tendency of misuse. The reasons for this observation are not clear but easy availability may have
contributed largely [7].
It is heartwarming to note that majority of caregivers who attended tertiary institution did not give
antibiotics to their children. This shows that use or
misuse of antibiotics decreases with increasing level
of education.
Conclusion
Management of acute diarrhea is characterized by
unnecessary and erratic use of antibiotics.
Journal of Tropical Pediatrics

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Gender of caregiver respondent

Male
124
59
Female
86
41
Has your ward ever passed watery stool?
Yes
184
87.6
No
26
12.4
Have you ever used unprescribed antibiotics for
an episode of diarrhea for your ward?
Yes
98
46.7
No
112
50.3
Educational level of the caregiver
None
1
0.5
First school leaving
30
14.3
certificate (FLSC)
83
39.5
Senior secondary
certificate examination
(SSCE)
Tertiary
96
45.7

Frequency n 98

BRIEF REPORT

References

Journal of Tropical Pediatrics

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