Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital
Keywords:Antibiotics, In patients, Rational use
Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit.
Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, antimicrobial use, culture and sensitivity reports, concomitant disease, concomitantly administered drugs, as well as clinical response were collected. The prescribed antimicrobials were correlated with the patient’s culture and sensitivity report. The number of defined daily doses (DDDs) administered per patient was calculated for each antimicrobial prescribed as per WHO anatomical therapeutic chemical classification. The ADR observed during the study were assessed using WHO causality analysis. The economic burden of the antimicrobial used was analyzed using average cost of antimicrobial per patient. The study was approved by the Institute Ethics Committee.
Results: The antimicrobials that are commonly used as per total drug use (DDDs) are ceftriaxone followed by doxycycline and metronidazole. The antimicrobials account for 58.6% of cost spent on drugs for inpatients. Four antimicrobial related ADR were reported during the study period.
Conclusion: Ceftriaxone, doxycycline, and metronidazole are commonly used antibiotics and significant proportion of the cost of drugs is spent for antimicrobials in a medicine unit.
Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, et al. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009;53(12):5046-54.
Hornsey M, Phee L, Wareham DW. A novel variant, NDM-5, of the New Delhi metallo-ß-lactamase in a multidrug-resistant Escherichia coli ST648 isolate recovered from a patient in the United Kingdom. Antimicrob Agents Chemother. 2011;55(12):5952-4.
Nordmann P, Boulanger AE, Poirel L. NDM-4 metallo-ß-lactamase with increased carbapenemase activity from Escherichia coli. Antimicrob Agents Chemother. 2012;56(4):2184-6.
Coast J, Smith R, Karcher AM, Wilton P, Millar M. Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance? Health Econ. 2002;11(7):637-47.
Coast J, Smith RD. Economics of antimicrobial resistance: a brief review. J Drug Assess. 2002;5:3-10.
Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant Gram-negative bacteria. Antimicrob Agents Chemother. 2010;54(1):109-15.
Dang A, Bhandare PN. The profile of voluntary reported adverse drug reactions at a tertiary care hospital: a fifteen month prospective study. J Clin Diagn Res. 2012;6:1504-9.
WHO Collaborating Center for Drug Statistics Methodology, 2013. Available at http://www.whocc.no. Accessed 15 October 2013.
Meyboom RH, Hekster YA, Egberts AC, Gribnau FW, Edwards IR. Causal or casual? The role of causality assessment in pharmacovigilance. Drug Saf. 1997;17(6):374-89.
Pathak A, Mahadik K, Dhaneria SP, Sharma A, Eriksson B, Lundborg CS. Surveillance of antibiotic consumption using the “focus of infection” approach in 2 hospitals in Ujjain, India. PLoS One 2012;7(6):e38641.
Ozgenç O, Genç VE, Ari AA, El Sibel, Saçar S, Ozunlu H, et al. Evaluation of the therapeutic use of antibiotics in Aegean Region hospitals of Turkey: a multicentric study. Indian J Med Microbiol. 2011;29(2):124-9.
Khan FA, Singh VK, Sharma S, Singh P. A prospective study on the antimicrobial usage in the medicine department of a tertiary care teaching hospital. J Clin Diagn Res. 2013;7(7):1343-6.
Badar VA, Navale SB. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in Central India. J Assoc Physicians India. 2012;60:20-3.
Samonis G, Gikas A, Anaissie EJ, Vrenzos G, Maraki S, Tselentis Y, et al. Prospective evaluation of effects of broad-spectrum antibiotics on gastrointestinal yeast colonization of humans. Antimicrob Agents Chemother. 1993;37(1):51-3.
Donskey CJ, Chowdhry TK, Hecker MT, Hoyen CK, Hanrahan JA, Hujer AM, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med. 2000;343:1925-32.
Davey PG, Marwick C. Appropriate vs. inappropriate antimicrobial therapy. Clin Microbiol Infect. 2008;14 Suppl 3:15-21.
Rush DR. Antimicrobial formulary management: meeting the challenge in the community hospital. Pharmacotherapy. 1991;11(1):19S-26.
Uppal R, Jhaj R, Malhotra S. Adverse drug reactions among inpatients in a north Indian referral hospital. Natl Med J India. 2000;13(1):16-8.
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5.
Rawlins MD. Spontaneous reporting of adverse drug reactions. I: the data. Br J Clin Pharmacol. 1988;26:1-5.
Karch FE, Smith CL, Kerzner B, Mazzullo JM, Weintraub M, Lasagna L. Adverse drug reactions-a matter of opinion. Clin Pharmacol Ther. 1976;19:489-92.
Patented Medicine Prices Review Board, Canada Fifth Annual Report, for the Year Ended December 31, 1992. Ottawa: Ministry of Supply and Services Canada; 1993: 16-8.
Daly JS, Worthington MG, Razvi SA, Robillard R. Intravenous and sequential intravenous and oral ciprofloxacin in the treatment of severe infections. Am J Med. 1989;87(5A):232S-4.
Nelson JD, Bucholz RW, Kusmiesz H, Shelton S. Benefits and risks of sequential parenteral – oral cephalosporin therapy for suppurative bone and joint infections. J Pediatr Orthop. 1982;2(3):255-62.