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Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia


Inappropriate use of antibiotics in human and animal is one of the causes of antimicrobial resistance. This study evaluates the prevalence and predictors of antibiotic use among pediatric patients visiting the Emergency Department (ED) in Malaysia. A retrospective cross-sectional study was conducted in the ED of a tertiary hospital. Data of children aged 2 to 11 years who visited the ED from January–May 2015 were extracted from the patient’s assessment forms. A total of 549 children were included in the analysis (median age 5 years) of which 54.3% were boys. Upper respiratory tract infections (URTI) were the most common diagnosis. Antibiotic was prescribed in 43.5% of the children. Children who visited the ED during the weekend (OR, 1.65; 95% confidence interval (CI) 1.13–2.40, P = 0.009), those diagnosed with URTI (OR 3.81; 95% CI, 2.45–5.93, P < 0.001) and those with a longer duration of fever (OR, 1.31; 95% CI, 1.15–1.48, P < 0.001) were more likely to have an antibiotic prescription.

Conclusions: Antibiotic was prescribed in more than one-third of children who visited the ED and antibiotic use was associated with visits during the weekend, URTI, and duration of fever. Antimicrobial stewardship program is recommended in the pediatric ED to improve appropriate use of antibiotics.

What is Known:
•Use of antibiotic among children increases the risk of antibiotic resistance and adverse drug reactions.
•Patient-, clinical-, and prescriber-related factors are three important domain associated with antibiotic use in children.
What is New:
•Fever and upper respiratory tract infections account for majority of antibiotic prescriptions.
•The “weekend effect” influences the use of antibiotics in the ED while upper respiratory tract infection is the strongest predictor of antibiotic use among children visiting the ED.

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Asian Network for Surveillance of Resistant Pathogens


Confidence interval


Emergency Department


Interquartile range


Medical officer


Odds ratio


Serious bacterial infections


Upper respiratory tract infections


United States


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We would like to acknowledge the Director General of Health Malaysia for the permission to publish this report. We wish to thank the Director of Hospital Tengku Ampuan Afzan for the permission to conduct this study.

Author information

Conceptualization: Daniel Tham Je Wai and Balamurugan Tangiisuran; Methodology: Daniel Tham Je Wai, Balamurugan Tangiisuran; Formal analysis and investigation: Daniel Tham Je Wai, Usman Abubakar, and Balamurugan Tangiisuran; Writing—original draft preparation: Daniel Tham Je Wai and Usman Abubakar; Writing—review and editing: Usman Abubakar and Balamurugan Tangiisuran; Resources: Daniel Tham Je Wai and Balamurugan Tangiisuran; Supervision: Balamurugan Tangiisuran. All authors read and approved the final manuscript.

Correspondence to Balamurugan Tangiisuran.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Medical Research and Ethics Committee, Ministry of Health Malaysia, reference number: 15-1648-27798) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Tham, D.W.J., Abubakar, U. & Tangiisuran, B. Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia. Eur J Pediatr (2020). https://doi.org/10.1007/s00431-019-03560-z

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  • Antibiotic
  • Pediatric
  • Emergency Department
  • Upper respiratory tract infection