A prospective assessment of antimicrobial agents utilization pattern in a tertiary care hospital
Keywords:Antimicrobial utilization pattern, Anatomical Therapeutic and Chemical - ATC, Essential Drug List- EDL, World Health Organization - WHO
Background: The antimicrobial resistance is increasing globally and, concurrently, downward trend in development of newer antibiotics is leading to a serious public health problem and economic consequences.
Methods: Prescriptions with at least one antimicrobial were included in the study. A total of 242 prescriptions were included in the study. The antimicrobials were classified into different classes based on WHO-ATC classification.
Results: A total of 281 antimicrobials prescribed in 242 prescriptions with an average of 1.16 per prescription. In most of the prescriptions, 1 antimicrobial were prescribed (88.43%). The routes of the antimicrobial administration were mostly oral 268 (95.37%) followed by injectable 13 (4.63%). The most commonly prescribed classes of antimicrobial in this study were antibacterials for systemic use (J01) (74.02%) followed by antimycobacterials (J04) (13.88%), antiparasitic drugs (P) (8.19%), antimycotics for systemic use (J02) (2.49%) and antivirals for systemic use (J05) (1.42%). Among antibacterials, the most commonly prescribed classes of antibacterial was various antibacterial FDCs (19.22%), followed by quinolones (18.86%), macrolides (18.15%), β-lactams (11.03%) cephalosporins (6.76%), penicillins (4.27%), aminoglycosides (2.84%), metronidazole (1.78%), clindamycin (1.78%) and tetracycline (0.36%). The total percentage of antimicrobials prescribed as Fixed Dose Combinations (FDCs) were 32.38%.
Conclusions: The present study has reported that most commonly prescribed antimicrobials were quinolones followed by macrolides and β-lactams. Recommendations to change the ongoing prescribing practices should be based on the Standard Treatment Guidelines, EDL and Antibiotic policy or by following the information, education, and communication (IEC) interventions.
WHO. Introduction to drug utilization research/WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services 2003.
Cars O, Mosltad S, Melander. A. Variation in antibiotic use in the European Union. Lancet. 2001;357:1851-3.
Wise R, Hart T, Cars O. Antimicrobial resistance. Is a major threat to public health. BMJ. 1998;317:609-10.
Gold HS, Moellering RC. Antimicrobial drug resistance. New England Journal of Medicine. 1996;335:1445-53.
Kakkilaya BS. Rational use of antibiotics. Available from: http://www.rational medicine.org/antibiotics.htm.
Rosdahl VT, Pedersen KB. The Copenhagen Recommendations. Report from the Invitational EU Conference on the Microbial Threat. Copenhagen, Denmark 9-10 September 1998. Available from: http://soapimg.icecube.snowfall.se/strama/ Kopenhamnsmotet_1998.pdf.
Howell L. Global Risks: An Initiative of the Risk Response Network. Geneva, World Economic Forum, 2013.
Kaplan W, Laing R. Priority Medicines for Europe and the World 2004. Available from: http://apps. who.int/iris/bitstream/10665/68769/1/WHO_ EDM_PAR_2004.7.pdf.
Cizman M. The use and resistance to antibiotics in the community. Int J Microb Agents. 2003;21:297-307.
Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014 Aug;14(8):742-50.
Finch RG. Antibiotic resistance: a view from the prescriber. Nat Rev Micro. 2004;2(12):989-94.
Soumerai SB. Factors influencing prescribing. Aust J Hosp Pharm. 1988;18:9-16.
Krishnaswamy K, Dinesh Kumar B, Radhaiah G. A drug survey precepts and practices. Eur J clinpharmacol. 1985;29:363-70.
Khan FA, Singh VK, Sharma S, Singh P. Prospective Study on the Antimicrobial Usage in the Medicine Department of a Tertiary Care Teaching Hospital. JCDR. 2013;7(7):1343-46.
Selvaraj R. Prospective assessment of antimicrobial prescribing pattern at a tertiary care hospital. Al Ameen J Med Sci. 2015;8(4):276-80.
Admane PD, Hiware SK, Mahatme MS, Dudhgaonkar SD, Deshmukh SN, Mahajan MM. Prescription pattern of antimicrobials in tertiary care hospital in central India. Int J of Pharmacol Research. 2015;5(2).
Lalan BK, Hiray RS, Ghongane BB. Drug prescription pattern of outpatients in a tertiary care teaching hospital in Maharashtra. Int J Pharm Bio Sci. 2012 July;3(3):225-9.
Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AFB. The development of standard values for the WHO drug use prescribing indicators. ICUM/EDM/WHO. http://archives.who.int/prduc2004/rducd/ICIUM_Posters/1a2_txt.htm.