Trends, correlates, and recent pattern of antibiotic misuse in acute rotavirus diarrhea in urban and rural Bangladesh

BackgroundThe indiscriminate use of antibiotics in pediatric populations has emerged as a critical global public health concern. A notable example of this is the misuse of antibiotics for treating rotavirus infections, particularly in developing countries. Despite this, there is a dearth of comprehensive research from this region. To address this gap, this study systematically examined the trends and factors associated with antibiotic misuse for acute rotavirus diarrhea among children aged 6-23 months in Bangladesh over a 15-year period. The study also explored sources of prescription, and types of antibiotics utilized in both urban and rural settings of Bangladesh. MethodsData from the icddr,bs Diarrhea Disease Surveillance System (DDSS) were analyzed for 4870 children with laboratory-confirmed acute rotavirus diarrhea treated at Dhaka (urban) and Matlab (rural) hospitals between 2004 and 2018. Relevant sociodemographic and epidemiological data was obtained from the database. To assess changes in antibiotic use over the years chi-square test for trend was employed. Separate logistic regression models specific to each site were developed to identify factors linked to antibiotic use in cases of rotavirus diarrhea. ResultsOver the study period, the percentage of children with rotavirus diarrhea treated with antibiotics significantly rose in both urban (from 43% to 75.5%) and rural (from 35% to 69%) settings (p<0.001). In urban areas, a majority of children (57.5%) received antibiotics at a physicians clinic for their illness, whereas almost all rural children (86.3%) obtained antibiotics from a pharmacy before being treated at icddr,b. Macrolides were identified as the most frequently prescribed antibiotics (46.6% in urban areas and 38% in rural areas). The urban regression model, revealed that factors such as severity of illness (OR = 1.8; 95% CI 1.5, 2.2), mothers education (OR = 2.1; 95% CI 1.6, 2.8), fathers education (OR = 1.8; 95% CI 1.4, 2.3), household monthly income > $100 (OR = 1.5; 95% CI 1.2, 1.9), and the distance from home to the nearest health facility (OR = 1.4; 95% CI 1.1, 1.9) were all significantly positively correlated with the use of antibiotic among children suffering from rotavirus diarrhea. Similar results were observed in the rural regression model. ConclusionsThe increasing trend of antibiotic misuse for rotavirus diarrhea in Bangladesh, coupled with the tendency of healthcare providers to prescribe antibiotics inappropriately and the higher incidence of misuse among affluent, educated families, is alarming. Future research is therefore imperative to elucidate the hindrances and catalysts to the prudent administration of antibiotics across diverse societal groups, encompassing both healthcare personnel and family members.