{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:28:23Z","timestamp":1789201703529,"version":"build-2803163510"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,6]]},"abstract":"<jats:p>Antimicrobial overuse contributes to antimicrobial resistance. Empiric use of antimicrobials for diarrheal illness is warranted only in a minority of cases, because of its self-limiting nature and multifactorial etiology. This study aims to describe the factors contributing to antimicrobial overuse for diarrheal disease among children less than 5 years of age in rural Bangladesh. A total of 3,570 children less than 5 years of age presenting with diarrhea in a tertiary level hospital were enrolled in the study. The rate of antimicrobial use at home was 1,395 (39%), compared with 2,084 (89%) during a hospital visit. In a multivariate analysis, factors associated with antimicrobial use at home included residence located more than 5 miles from a hospital; use of zinc and oral rehydration salts at home; vomiting; greater than 10 stools per 24 hours; diarrheal duration greater than 3 days; and rotavirus diarrhea (<jats:italic>P<\/jats:italic> &lt; 0.05 for all). Characteristics of children more likely to be given antimicrobials in a health-care setting included greater than 10 stools per 24 hours; duration of diarrhea greater than 3 days; use of antimicrobials before hospital presentation; fever (\u2265 37.8\u00b0C); rectal straining; and <jats:italic>Shigella<\/jats:italic> infection (<jats:italic>P<\/jats:italic> &lt; 0.05 for all). The most commonly used drugs in rotavirus diarrhea were azithromycin and erythromycin, both before hospital presentation and during hospital admission. Our study underscores the importance of diligent vigilance on the rationale use of antimicrobials both at home and in health-care facilities with a special concern for children less than 5 years of age living in rural Bangladesh.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0988","type":"journal-article","created":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T07:00:23Z","timestamp":1525158023000},"page":"1571-1576","source":"Crossref","is-referenced-by-count":25,"title":["Burden and Risk Factors of Antimicrobial Use in Children Less Than 5 Years of Age with Diarrheal Illness in Rural Bangladesh"],"prefix":"10.4269","volume":"98","author":[{"given":"Shahnawaz","family":"Ahmed","sequence":"first","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonum","family":"Korpe","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abu Syed Golam","family":"Faruque","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"BMC Infect Dis","first-page":"424","article-title":"Antimicrobial stewardship in paediatrics","volume":"16","author":"Principi","year":"2016"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"155","article-title":"The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America","volume":"46","author":"Spellberg","year":"2008"},{"key":"b3","series-title":"Int J Environ Res Public Health","first-page":"3246","article-title":"Descriptive study on parents\u2019 knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus","volume":"8","author":"Rousounidis","year":"2011"},{"key":"b4","series-title":"BMJ","first-page":"c2096","article-title":"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","volume":"340","author":"Costelloe","year":"2010"},{"key":"b5","series-title":"Pediatr Infect Dis J","first-page":"974","article-title":"Selection of antibiotic-resistant pathogens in the community","volume":"25","author":"Yagupsky","year":"2006"},{"key":"b6","author":"Holloway","year":"2011"},{"key":"b7","author":"World Health Organization","year":"2013"},{"key":"b8","series-title":"Lancet","first-page":"209","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study","volume":"382","author":"Kotloff","year":"2013"},{"key":"b9","author":"World Health Organization","year":"2014"},{"key":"b10","series-title":"Sci J Clin Med","first-page":"81","article-title":"Urban-rural differentials in using antimicrobials at home among under-5 children with diarrhea","volume":"2","author":"Ahmed","year":"2013"},{"key":"b11","series-title":"JAMA","first-page":"875","article-title":"Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis","volume":"279","author":"Nyquist","year":"1998"},{"key":"b12","series-title":"Arch Pediatr Adolesc Med","first-page":"800","article-title":"Parent expectations for antibiotics, physician-parent communication, and satisfaction","volume":"155","author":"Mangione-Smith","year":"2001"},{"key":"b13","series-title":"BMC Pediatr","first-page":"41","article-title":"Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998\u20132004","volume":"9","author":"Coco","year":"2009"},{"key":"b14","series-title":"Clin Infect Dis","first-page":"S170","article-title":"Patients\u2019 interviews and misuse of antibiotics","volume":"33 (Suppl 3)","author":"Pechere","year":"2001"},{"key":"b15","series-title":"Avicenna J Clin Microbiol Infect","first-page":"e32087","article-title":"Follow-up trends of bacterial etiology of diarrhoea and antimicrobial resistance in urban areas of Bangladesh","volume":"2","author":"Sami","year":"2015"},{"key":"b16","series-title":"J Gastrointest Dig Syst","first-page":"2","article-title":"Shigellosis among breastfed children: a facility based observational study in rural Bangladesh","volume":"5","author":"Ahmed","year":"2015"},{"key":"b17","series-title":"J Clin Microbiol","first-page":"2088","article-title":"Genetic characterization of a novel, naturally occurring recombinant human G6P [6] rotavirus","volume":"41","author":"Rahman","year":"2003"},{"key":"b18","series-title":"Emerg Infect Dis","first-page":"1104","article-title":"Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh, 2004","volume":"11","author":"Qadri","year":"2005"},{"key":"b19","series-title":"Trans R Soc Trop Med Hyg","first-page":"299","article-title":"The aetiology of diarrhoea in children at an urban hospital in Bangladesh","volume":"81","author":"Moyenuddin","year":"1987"},{"key":"b20","series-title":"J Clin Microbiol","first-page":"27","article-title":"Prevalence of toxin types and colonization factors in enterotoxigenic Escherichia coli isolated during a 2-year period from diarrheal patients in Bangladesh","volume":"38","author":"Qadri","year":"2000"},{"key":"b21","series-title":"Clin Infect Dis","first-page":"S232","article-title":"The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case\/control study","volume":"55 (Suppl 4)","author":"Kotloff","year":"2012"},{"key":"b22","series-title":"Epidemiol Infect","first-page":"90","article-title":"Aetiology and clinical features of dysentery in children aged < 5 years in rural Bangladesh","volume":"142","author":"Ferdous","year":"2014"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"223","article-title":"Severity of diarrhea and malnutrition among under five-year-old children in rural Bangladesh","volume":"89","author":"Ferdous","year":"2013"},{"key":"b24","series-title":"Bangladesh J Med Sci","first-page":"1","article-title":"Evolving antibiotic resistance: a great threat to medical practice","volume":"11","author":"Chowdhury","year":"2012"},{"key":"b25","series-title":"BMC Infect Dis","first-page":"155","article-title":"Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: a cross-sectional study in Ujjain, India","volume":"12","author":"Sharma","year":"2012"},{"key":"b26","series-title":"J Pharm Bioallied Sci","first-page":"335","article-title":"Prescription patterns and appropriateness of antibiotics in the management of cough\/cold and diarrhea in a rural tertiary care teaching hospital","volume":"8","author":"Ahmad","year":"2016"},{"key":"b27","series-title":"BMC Public Health","first-page":"847","article-title":"Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi city","volume":"14","author":"Biswas","year":"2014"},{"key":"b28","series-title":"BMC Health Serv Res","first-page":"136","article-title":"Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh","volume":"17","author":"Saha","year":"2017"},{"key":"b29","series-title":"Bull World Health Organ","first-page":"930","article-title":"Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia","volume":"88","author":"Togoobaatar","year":"2010"},{"key":"b30","series-title":"BMJ","first-page":"266","article-title":"Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial","volume":"336","author":"Roy","year":"2008"},{"key":"b31","author":"World Health Organization","year":"2012"},{"key":"b32","author":"Onwukwe","year":"2014"},{"key":"b33","series-title":"Cochrane Database Syst Rev","first-page":"CD005436","article-title":"Oral zinc for treating diarrhoea in children","volume":"12","author":"Lazzerini","year":"2016"},{"key":"b34","series-title":"BMC Public Health","first-page":"788","article-title":"Harmful practices in the management of childhood diarrhea in low-and middle-income countries: a systematic review","volume":"15","author":"Carter","year":"2015"},{"key":"b35","series-title":"Iran J Public Health","first-page":"1356","article-title":"Rota viral infection: a significant disease burden to Libya","volume":"43","author":"Alkoshi","year":"2014"},{"key":"b36","series-title":"J Trop Pediatr","first-page":"314","article-title":"Use and\/or misuse of antibiotics in management of diarrhea among children in Enugu, southeast Nigeria","volume":"59","author":"Ekwochi","year":"2013"},{"key":"b37","series-title":"J Med Assoc Thai","first-page":"178","article-title":"Study on the management of diarrhea in young children at community level in Thailand","volume":"80","author":"Wongsaroj","year":"1997"},{"key":"b38","series-title":"BMC Public Health","first-page":"690","article-title":"Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam","volume":"11","author":"Rheinl\u00e4nder","year":"2011"},{"key":"b39","series-title":"PLoS One","first-page":"e0138179","article-title":"Inappropriate use of antibiotics and its associated factors among urban and rural communities of Bahir Dar city administration, northwest Ethiopia","volume":"10","author":"Gebeyehu","year":"2015"},{"key":"b40","series-title":"Bangladesh J Microbiol","first-page":"19","article-title":"Multiple-antibiotic resistance mediated by plasmids and integrons in uropathogenic Escherichia coli and Klebsiella pneumoniae","volume":"24","author":"Lina","year":"2007"},{"key":"b41","series-title":"Int J Community Med Public Health","first-page":"2620","article-title":"A systematic review of the literature on survey questionnaires to assess self-medication practices","volume":"4","author":"Limaye","year":"2017"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/6\/article-p1571.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/6\/article-p1571.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/6\/article-p1571.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T17:13:07Z","timestamp":1722445987000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/6\/article-p1571.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,6]]},"references-count":41,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0988","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,6]]}}}