The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia
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BACKGROUND: Dengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics. METHODS: A retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015. RESULTS: There were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case. CONCLUSION: The use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.
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The use of antibacterial drugs in treating viral infections was mostly reported in studies conducted in the Middle East and Asia.
“This use of antibacterial drugs in treating viral infections was mostly reported in studies conducted in the Middle East and Asia [13, 48].”
From Prevalence and associated factors of self-medication with antibiotics among pediatric population in India: a systematic review and meta-analysis (2025) · cites this paper as [48]
The Methods describe a study of antibiotic use in children with dengue in Bandung, Indonesia, and the Discussion reports antibiotic overprescription in those patients. The paper therefore provides an Asian example, but it does not establish that studies reporting antibiotic use for viral infections were conducted mostly in the Middle East and Asia; it does not address the Middle East or compare where such studies were conducted. (LLM, conf=0.82)
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- Authors
- Adrizain, R., Setiabudi, D., & Chairulfatah, A.
- Affiliations
- Dr. Hasan Sadikin General Hospital (ID)
- Corresponding author
- Adrizain, Riyadi
- Setiabudi, Djatnika
- Chairulfatah, Alex
- Venue
- PLOS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-06-21
- Volume
- 13
- Issue
- 6
- Pages
- e0007438
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC6608981
- OpenAlex
- W2950754789
- Cited by
- 25
- References
- 26
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 7
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Update notices
- new_version (2019-07-03)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- ALG Universitas Padjadjaran
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- dengue, children, inappropriate antibiotic use, antibiotic prescribing, bacterial co-infection, upper respiratory tract infection, typhoid fever, urinary tract infection, third-generation cephalosporins, amoxicillin, teaching hospitals, private hospitals, diagnostic accuracy, Bandung, antimicrobial stewardship, nosocomial infections
- MeSH terms
- Adolescent, Anti-Bacterial Agents, Bacterial Infections, Child, Child, Preschool, Dengue, Diagnostic Tests, Routine, Drug Utilization, Female, Health Services Research, Hospitals, Teaching, Humans, Indonesia, Infant, Infant, Newborn, Male, Retrospective Studies, Hospitals, Private
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