DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20174354

A prospective cross-sectional study on prescribing pattern of antibiotics on patients suffering from ENT infections in tertiary care hospital, Pokhara, Nepal

Surendra P. Gupta, Salikram Poudel, Anil P. Gupta, Basanta Bashyal, Bishal Baskota, Anil K. Sah, Subash Pandaya, Dhiraj Shrestha

Abstract


Background: This survey was designed to assess and evaluate the prescribing pattern of antibiotics used in patients suffering from ENT (Eye, Nose, and Throat) infections in ENT outpatient departments (OPD) at Manipal Teaching Hospital (MTH), Phulbari, Pokhara, Nepal.

Methods: A prospective cross-sectional study was conducted in out-patients of ENT department at MTH for 6 month in which a total of 216 prescriptions were observed randomly and data filled patient profile forms were collected and analyzed.

Results: Out of 216 patients, 126(58.33%) were male and 90 (41.67%) were female. Patients of age group 21-30 were maximum (29.16%) followed by age group of 11-20 (22.22%). Only 6.7% of drugs were prescribed from their generic names. Data analysis revealed that about 72.24%, 24.53% and 3.23% of prescription contained one, two and three antibiotic drugs respectively. All together 970 drugs were prescribed in 216 prescriptions out of which 251 (25.87%) were antibiotics drugs. This suggested that the average no. of antibiotics per prescription was 1.16. Among prescribed antibiotics, Amoxicillin (7.56%) of penicillin group, Azithromycin (8.36%) of macrolides, Cefuroxime (9.56%) of 2nd generation cephalosporin followed by Cefpodoxime (32.27%) of 3rd generation cephalosporin and Ofloxacin (6.37%) of quinolones group were frequently prescribed. From analysis, we found that other concomitant medications were also prescribed such analgesics, antihistamines, PPI (Proton Pump Inhibitors) and vitamins, minerals and dietary enzymes. The prescribed antibiotics accounted for large percentage of oral dosage forms (89.90%) followed parental injection dosage forms 5.05%.

Conclusions: Prescribing more than one antibiotics was commonly encountered indicating the occurrence of polypharmacy which were based on empirical therapy without any culture and sensitivity test report. Therefore, local hospital culture sensitivity database for ENT infections has to be developed and prescribing with generic name from existing essential drug list or formulary should be encouraged for rational drug therapy.


Keywords


Antibiotics, ENT infections, Empirical therapy, Generic names, MTH, Prescribing pattern, Polypharmacy

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References


Grace NN, Bussmann RW. Traditional management of ear, nose and throat (ENT) diseases in Central Kenya. J. Ethnomed. 2006;2:54.

Sivakumar P, Razak TA, Perumal P. Drug utilization of antimicrobials in ENT patients. Asian Journal of Pharmaceutical and Clinical Research. 2011;4:123-25.

Remesh A, Salim S, Gayathri AM, Nair U, Retnavally KG. Antibiotics prescribing pattern in the in-patient department of a tertiary care hospital. Arch Pharma Practice. 2013;4(2):71-6.

Kumar J, Shaik MM, Kathi MC, Deka A, Gambhir SS. Prescribing indicators and patterns of use of antibiotics among medical outpatients in a teaching hospital of central Nepal. J of Col of Med Sci. 2010;6(2):7-13.

Gjelstad S, Dalen I, Lindbaek M. General physician’s antibiotic prescription patterns for respiratory tract infections-still room for improvement. Scandinavian Journal of Primary Health Care. 2009;27:208-15.

Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF. 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.

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.

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

Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari RB, et al. A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal. Kathmandu University Medical Journal. 2006;4(4):436-43.

Gaash B. Irrational Use of Antibiotics. Indian J. Practicing Doctor. 2008;5(1):55-9.

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 J of Cli Phar.1980;17:183-7.

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.

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 J of Pha. 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.

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.

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

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 J. 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.

Laporte JR. Towards a healthy use of pharmaceuticals. Development dialogue. 1985;2:48-55.

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.

Begum MM, Uddin MS, Rahman MS, Nure MA, Saha RR, Begum T, et al. Analysis of prescription pattern of antibiotic drugs on patients suffering from ENT infection within Dhaka Metropolis, Bangladesh. Int J Basic Clin Pharmacol. 2017;6:257-64.

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.

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.

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

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.

Pal A, Bhowmick S, Basu J, Chattopadhyay R, Paul SS, Chattopadhyay S. Study on Prescribing Pattern of Antimicrobials in ENT Department of a Tertiary Care Teaching Hospital in Bihar, India. World Journal of Pharmaceutical Research. 2015;4:1839-52.

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.

Ansari KU, Singh S, Pandey RC. Evaluation of prescribing pattern of doctors for rational drug therapy. Indian Journal of Pharmacology. 1998;30:43-6.

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 Pha. 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.

Abubakar K, Abdulkadir R, Abubakar MR, Ugwah-Oguejiofor JC, Abubakar SB. Pattern of Drug Utilization in the Treatment of Chronic Suppurative Otitis Media in a Tertiary Health Institution in Kaduna, Nigeria. Journal of Health Science. 2014;4:7-10.

Lisha JJ, Meenu C, Jayadevan S, Tambi C. Patterns of Antimicrobial therapy in acute tonsillitis: A cross-sectional Hospital-based study from UAE. Annals of the Brazilian Academy of Sciences. 2014;86(1):451-7.