Meta-analysis estimates 44% inappropriate antibiotic use in African pediatric care

Researchers searched PubMed, Web of Science and African Journals Online for studies of inappropriate antibiotic use in children across Africa. Of 3,085 records identified, 11 studies met inclusion criteria. The review followed PRISMA guidance, assessed study quality with the Mixed Methods Appraisal Tool and pooled estimates using a random-effects model.

The pooled prevalence of inappropriate antibiotic use was 44%. Country-level estimates ranged from 11% and 19.3% to as high as 75.1%, 73.9% and 71.5%. Pooled estimates were 51.2% in retrospective studies and 35.4% in prospective studies, with substantial heterogeneity in both groups (I² 99.5% and 99%, respectively). Reported problems included incorrect dosages (10.1%–19.5%) and durations (17.47%–18.8%). Use of three or more antibiotics was associated with inappropriate use (adjusted odds ratio 2.8; 95% CI 1.245–6.462). Younger age and prolonged hospitalization were also identified as risk factors. The findings point to a substantial stewardship challenge, but the small number of studies and marked variation between settings limit the precision and generalizability of the pooled estimate.