Drug utilization pattern in out-patients with respiratory tract infections in a rural teaching hospital: a prospective observational study

Paramita Pal, Dipankar Bhattacharyya, Kokila B. N., Herle M., Anoljyoti Ghosh, Sukanta Sen


Background: Respiratory tract infections are common clinical problems in the general population. Antimicrobials are the mainstay in the management and irrational use of them may increase resistance to bacteria and the total cost of treatment. Objectives: To evaluate the pattern of drug prescriptions for respiratory tract infections in Medicine and Pediatric outpatient departments of a rural teaching hospital.

Methods: Over a period of 18 months, 391 prescriptions of outpatients with respiratory tract infection were collected. The drugs prescribed, their dose and duration of treatment were recorded. DU 90% was calculated.

Results: The mean (±SEM) age of the patients was38.55±0.9 years and there were 204 (52.1%) men and 187 (42.1%) women. The most common disorder among the patients was acute rhinitis (61.1%) while the least common was acute bronchitis (1.3%). Microbial culture and sensitivity was done in 23 patients and Klebsiella pneumonia (8.2%) and enterococcus (0.07%) was the most common and least common organism respectively. Penicillins (50.9%), cephalosporins (26.7%), antitubercular drugs (8.5%), macrolides (4.8) constituted DU 90%. Monotherapy was advocated in 91.7% and multidrug therapy in 8.3% of patients. The average number of antimicrobials prescribed per prescription was 0.52. Two thirds (67.6%) of the prescribed drugs were from the national list of essential medicines 2011 (NLEM).

Conclusions: Penicillins and cephalosporins were the commonly used antibiotics for respiratory tract infection in outpatients of a rural teaching hospital and two thirds of the prescribed drugs were essential medicines.


Antimicrobial agents, Drug utilization, Respiratory tract infections

Full Text:



Finch RG. Epidemiological features and chemotherapy of community-acquired respiratory tract infections. Journal of antimicrobial chemotherapy. 1990;26:53.

Nandimath MK, Ahuja S. Drug prescribing pattern in upper respiratory tract infection in children aged 1-14 years. International Journal of Pharma and Bio Sciences. 2012;3(1):299-308.

Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatrics. 2001;68:1135-8.

Finegold SM, Johnson CC. Lower respiratory tract infection. The American Journal of Medicine. 1985;79(5):73-7.

Schaberg T, Torres A. Guidelines for management of adult community-acquired lower respiratory tract infections. Eur Respir J. 1998;11:986-91.

Guthrie R. Community-acquired lower respiratory tract infections: etiology and treatment. Chest. 2001;120(6):2021-34.

McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273:214-9.

Health Canada and the Canadian Infectious Disease Society. Controlling antimicrobial resistance. An integrated action plan for Canadians. Can Commun Dis Rep. 1997;23:1-32.

Zhanel GG, Karlowsky JA, Palatnick L, Vercaigne L, Low DE, Hoban DJ. Prevalence of antimicrobial resistance in respiratory tract isolates of Streptococcus pneumoniae: results of a Canadian national surveillance study. The Canadian Respiratory Infection Study Group. Antimicrob Agents Chemother. 1999;43:2504-9.

Whitney CG, Farley MM, Hadler JH, Harrison LH, Lexau C, Reingold A, et al. Increasing prevalence of multi-drug resistant Streptococcus pneumoniae in the United States. N Engl J Med. 2000;343:1917-24.

Chen DK, McGeer A, De Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med. 1999;341:233-9.

Davidson R, Cavalcanti R, Brunton JL, Bast DJ, De Azavedo JCS, Kibsey P, et al. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med. 2002;346:747-50.

Prajapati V, Bhatt JD. Study of prescribing patterns of antimicrobial agents in the paediatric wards at tertiary teaching care hospital, Gujarat. IJPSR. 2012;3(7):2348-55.

Nelson CR. Drug utilization in office practice: National Ambulatory Medical Care Survey, 1990. Adv Data 1993;232:1-12.

Kumari IKS, Chandy SJ, Jeyaseelan L, Kumar R, Suresh S. Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India. Indian J Med Res. 2008;128:165-71.

Gaash B. Irrational Use of Antibiotics. Indian Journal for the Practicing Doctor. 2008;5(1):03-4.

Naik HG, Khanwelkar CC, Kolur A, Desai A, Gidamudi S. Drug Utilization Study on Antibiotics use in Lower Respiratory Tract Infection. National Journal of Medical Research. 2013;3(4):324-7.

Naik HG, Khanwelkar CC, Kolur A, Desai A, Gidamudi S. Drug Utilization Study on Antibiotics use in Upper Respiratory Tract Infection. International Journal of Recent Trends in Science and Technology. 2014;10(2):299-302.

Patil L, Khairnar A. Ninety percent drug utilization in patients of upper respiratory infections: Int. Res. J. Pharm. 2013;4(6):189-93.

Iyer GS, Patel PP, Panchal JR, Dikshit RK. An analysis of the pharmacological management of respiratory tract infections in pediatric in-patients at a tertiary care teaching hospital. International J of Medicine and Public Health. 2013;3(3):140-5.