Published: 2017-01-28

Analysis of prescription pattern of antibiotic drugs on patients suffering from ENT infection within Dhaka Metropolis, Bangladesh

Mst. Marium Begum, Md. Sahab Uddin, M. Sohanur Rahman, Most. Akhlatun Nure, Rita Rani Saha, Taslima Begum, Rayhana Begum, Azharul Islam, Mahmuda Sultana, Rubaba Karim


Background: This survey was designed to assess and evaluate the prescription pattern of antibiotic drugs on patients suffering from ENT infection within Dhaka Metropolis, Bangladesh.

Methods: A cross sectional, observational and prospective study was conducted from January to June 2015 in the out-patients (OPD) and in-patients (IPD) of ENT department at different general and specialized government and private hospitals (Dhaka Medical College and Hospital, Sir Solimullah Medical College Mitford Hospital, Holy Family Red Crescent Medical College and Hospital, Dhaka Community Medical College and Hospital) within Dhaka city.300 prescriptions were collected and randomly evaluated for this present study.

Results: Out of 300 patients, 220 (73.33%) were male and 80 (26.67%) were female (including children and adults) where most of the patients were outpatients 262 (87.33%). In the patients information section it was observed that approximately 93.33%  prescription contained antibiotic drugs and almost all prescription (100%) contained antibiotic drugs along with other drugs such as 80.67% PPI (proton pump inhibitors), 76.67% analgesic and 51.33% vitamin/ iron supplements. From this analysis we found that 19.33% prescription contained single antibiotic drug, 80.67% contained two antibiotic drugs and no prescription contained more than two antibiotic drugs. Most of the prescribed drugs were administered orally (12% capsule, 80% tablet form). Out of 473 prescribed antibiotic drugs majority of them lie underβ-Lactam (54%) class followed by cephalosporin (46.33%) class in which maximum drugs (92%) were prescribed by their brand names.

Conclusions: Prescribing more than one antibiotics was commonly encountered in this study indicating the occurrence of polypharmacy. Interventions to rectify over prescription of antibiotics, use of brand names, inadequate labelling of drugs is necessary to improve rational drug use. Standard treatment guidelines, hospital formulary, and educational intervention become essential to modify this behaviour to benefit the patient.


Antibiotics, Brand name, Bangladesh, ENT infections, Generic name, Polypharmacy, Prescribing pattern

Full Text:



WHO. World Health Statistics 2008: Mortality and Burden of Disease. Geneva: WHO; 2008:36-64.

Njoroge GN, Bussmann RW. Traditional management of ear, nose and throat (ENT) diseases in Central Kenya. Journal of Ethnobiology and Ethnomedicine. 2006;2:54.

Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah, F, Abera SF, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. The Lancet. 2015;386:2145-91.

Linder JA, Singer DE, Stafford RS. Association between antibiotic prescribing and visit duration in adults with upper respiratory tract infections. Clinical therapeutics. 2003;25:2419-30.

Mossad SB. Upper respiratory tract infections. Clevel and Clinic. Department of Infectious Disease; 2015.

Hueston WJ, Mainous AG, Ornstein S, Pan Q, Jenkins R. Antibiotics for upper respiratory tract infections: follow-up utilization and antibiotic use. Archives of family medicine. 1999;8:426.

Hirschmann JV. Antibiotics for common respiratory tract infections in adults. Archives of internal medicine. 2002;162:256-64.

World Health Organization. Cough and cold remedies for the treatment of acute respiratory infections in young children; 2001;01-32.

Saketkhoo K, Januszkiewicz A, Sackner MA. Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. CHEST Journal. 1978;74:408-10.

Wiwanitkit S, Wiwanitkit V. Pyogenic brain abscess in Thailand. North American journal of medical sciences. 2012;4:245.

Anandhasayanam A, Kannan S, Md. Sajir, Zachariah N. Drug Prescription Pattern Observation at a ENT OPD Department in a Tertiary Care Hospital at Malappuram District of Kerala. Int J Pharm Sci Res. 2016;7:4157-63.

Lunde PKM, Baksaas I. Epidemiology of Drug Utilization‐Basic Concepts and Methodology. Acta Medica Scandinavica. 1987;222:7-11.

Bergman U, Christenson I, Jansson B, Wiholm BE. Auditing hospital drug utilisation by means of defined daily doses per bed-day a methodological study. European journal of clinical pharmacology. 1980;17:183-7.

Pradhan SC, Shewade DG, Shashindran CH, Bapna JS. Drug utilization studies. National Med J India. 1988;1;185-9.

Chaurasia RC. Medication errors in children. IAP Bulletin Academy Today. 2006;2:28-9.

Coco AS, Horst MA, Gambler AS. Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998-2004. BMC pediatrics. 2009;9:1.

Tariq TM. Bacteriologic profile and antibiogram of blood culture isolates from a children’s hospital in Kabul. J Coll Physicians Surg Pak. 2014;24:396-9.

Sutter DE, Bradshaw LU, Simkins LH, Summers AM, Atha M, Elwood RL, et al. High incidence of multidrug-resistant gram-negative bacteria recovered from Afghan patients at a deployed US military hospital. infection control and hospital epidemiology. 2011;32:854-60.

Dowell SF, Schwartz B. Resistant pneumococci: protecting patients through judicious use of antibiotics. American Family Physician. 1997;55:1647-54.

Issarachaikul R, Suankratay C. Antibiotic prescription for adults with upper respiratory tract infection and acute bronchitis at King Chulalongkorn Memorial Hospital, Thailand. Asian Biomed. 2013;7:15-20.

Sivagnanam G, Mohanasundaram J, Thirumalaikolundusubramanian P, Raaj AA, Namasivayam K, Rajaram S. A survey on current attitude of practicing physicians upon usage of antimicrobial agents in southern part of India. Medscape General Medicine. 2004;6:1.

World Health Organization. Antimicrobial resistance global report on surveillance: 2014.

Austin DJ, Kristinsson KG, Anderson, RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proceedings of the National Academy of Sciences. 1999;96:1152-6.

Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian Journal of Pharmacology. 2011;43:150.

Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. BMC health services research. 2013;13:1.

Krishnaswamy K, Kumar BD, Radhaiah G. A drug delivery percept and practices. Eur J Clin Pharmacol. 1985;29:363-70.

Biswas M, Roy DN, Tajmim A, Rajib SS, Hossain M, Farzana F, et al. Prescription antibiotics for outpatients in Bangladesh: a cross-sectional health survey conducted in three cities. Annals of clinical microbiology and antimicrobials. 2014;13:1.

Chang SC, Chang HJ, Lai MS. Antibiotic usage in primary care units in Taiwan. International Journal of Antimicrobial Agents. 1999;11:23-30.

Remesh A, Salim S, Gayathri AM, Nair U, Retnavally KG. Antibiotics prescribing pattern in the in-patient departments of a tertiary care hospital. Archives of pharmacy practice. 2013;4:71.

Bi P, Tong S, Parton KA. Family self-medication and antibiotics abuse for children and juveniles in a Chinese city. Social science and medicine. 2000;50:1445-50.

Okumura J, Wakai S, Umenai T. Drug utilisation and self-medication in rural communities in Vietnam. Social science and medicine. 2002;54(12):1875-86.

Chowdhury MMH, Kubra K, Islam MT, Rahman MM, Mehedy ME. Indiscriminate Uses of Antibiotics as a Threat to Public Health Demand Implementation of Effective Drug Practices and Enhancement of Public Awareness in Bangladesh. European Journal of Scientific Research. 2015;133:187-95.

Vaccheri A, Bjerrum L, Resi D, Bergman U, Montanaro N. Antibiotic prescribing in general practice: striking differences between Italy (Ravenna) and Denmark (Funen). Journal of Antimicrobial Chemotherapy. 2002;50:989-97.

Larson E, Lin S, Gomez-Duarte C. Antibiotic use in Hispanic households, New York City. Emerging infectious diseases. 2003;9:1096.

Dimina E, Kula M, Caune U, Vigante D, Liepiņš M, Zeidaka L, et al. Repeated prevalence studies on antibiotic use in Latvia, 2003-2007. Eurosurveillance. 2009;14:19307.

Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P, et al. Antimicrobial resistance is a major threat to public health. British Medical Journal. 1998;317:609-11.

WHO Action Programme on Essential Drugs, How to investigate drug use in health facilities, WHO/DAP/93.1. 1993;1-92.

Yadav P, Kanase V, Lacchiramka P, Jain S. Drug utilization trends in ENT outpatient department in a Teaching hospital. Int J Pharm Biol Sci. 2010;1:153-60.

Pallavi I, Shrivastava R, Sharma A, Singh P. Prescribe Pattern of Drugs and Antimicrobials Preferences in the Department of ENT at Tertiary Care SGM Hospital, Rewa, MP, India. Journal of Pharmaceutical and Biomedical Sciences. 2016;6:89-93.

Khan FA, Nizamuddin S, Salman MT. Patterns of prescription of antimicrobial agents in the Department of Otorhinolaryngology in a tertiary care teaching hospital. African Journal of Pharmacy and Pharmacology. 2011;5:1732-8.

Ain MR, Shahzad N, Aqil M, Alam MS, Khanam R. Drug utilization pattern of antibacterials used in ear, nose and throat outpatient and inpatient departments of a university hospital at New Delhi, India. Journal of Pharmacy and Bioallied Sciences. 2010;2:8.

Shankar PR, Upadhyay DK, Subish P, Dubey AK, Mishra P. Prescribing patterns among paediatric inpatients in a teaching hospital in western Nepal. Singapore Medical Journal. 2006;47:261.

Pradhan S, Jauhari AC. A study of antibiotics used in adult respiratory disorders in Kathmandu and Bhaktapur. Nepal. Med. Coll. J. 2007;9:120-4.

Gogoi S, Saikia PP. A study on prescribing patterns of antibiotics for upper respiratory tract infections by general practitioners in rural areas of Assam. International Journal of Scientific Research. 2016;4:60-1.

Bhat GM, Holla R, Kamath PSD. A study of prescription pattern in the drug therapy of ear, nose, and throat infections at a tertiary care hospital in Mangalore. Int J Basic Clin Pharmacol. 2015;4:686-90.

Charatan F. Family compensated for death after illegible prescription. BMJ. 1999;319:1456.

Ghosh R, Neogi JN, Srivastava BS, Sen P. Prescribing trends in a teaching hospital in Nepal. Journal of Nepal medical association. 2003;42:346-9.

Kumari R, Idris MZ, Bhushan V, Khanna A, Agrawal M, Singh SK. Assessment of prescription pattern at the public health facilities of Lucknow district. Indian journal of pharmacology. 2008;40:243.

Bhatnagar T, Mishra CP, Mishra RN. Drug prescription practices: a household study in rural Varanasi. Indian J Prev Soc Med. 2003;34:33-9.

Rasool BKA, Fahmy SA, Abu-Gharbieh EF, Ali HS. Professional practices and perception towards rational use of medicines according to WHO methodology in United Arab Emirates. Pharmacy practice. 2010;8:70.

Patel V, Vaidya R, Naik D, Borker P. Irrational drug use in India: a prescription survey from Goa. Journal of Postgraduate Medicine. 2005;51:9.

Sharif SI, Al-Shaqra M, Hajjar H, Shamout A, Wess L. Patterns of drug prescribing in a hospital in Dubai, United Arab Emirates. Libyan Journal of Medicine. 2008;3:10-2.

Vijayakumar TM, Sathyavati D, Subhashini T, Sonika G, Dhanaraju MD. Assessment of prescribing trends and rationality of drug prescribing. International Journal of Pharmacology. 2011;7:140-3.

Padwal SL, Kulkarni MD, Deshmukh VS, Patil JR, Jadhav SS, Jadhav AD. Drug use pattern in the ear, nose, throat outpatient department of a rural tertiary-care teaching hospital. National Journal of Physiology, Pharmacy and Pharmacology. 2015;5:212-6.

Raza UA, Khursheed T, Irfan M, Abbas M, Irfan UM. (Prescription patterns of general practitioners in Peshawar, Pakistan. Pak J Med Sci. 2014;30:462-5.

Deshmukh AC, Ghadlinge MS, Tamboli SB, Deshmukh JB, Chhabra RR. Study of rationality and utilization pattern of antimicrobials in ear, nose, throat outpatient department of Tertiary Care Hospital, Nanded. Int J Basic Clin Pharmacol. 2015;4:734-8.

Senok AC, Ismaeel AY, Al-Qashar FA, Agab WA. Pattern of upper respiratory tract infections and physicians’ antibiotic prescribing practices in Bahrain. Medical Principles and Practice. 2009;18:170-4.

Higashi T, Fukuhara S. Antibiotic prescriptions for upper respiratory tract infection in Japan. Internal medicine. 2009;48:1369-75.