A prospective study of antimicrobial drug utilization in infective diseases in pediatrics at Navodaya Medical College Hospital of Raichur, Karnataka, India
Keywords:Antimicrobials, Drug utilization evaluation, Prospective study, Rational drug use
Background: There is increased concern regarding the inappropriate use of antimicrobials resulting in emergence of resistant strains, unnecessary adverse effects and poor therapeutic outcome. This present study has been taken up with a view to analyze the use of various antimicrobial agents alone and/or in combination to combat diseases of infective origin in a proposed manner.
Methods: This was a prospective study carried out for a period of 1 year from January 2011 to December 2011. The prescriptions of all eligible patients were reviewed on daily basis and all the relevant data were retrieved to assess the utilization pattern of antimicrobials and also their safety and potential interactions.
Results: A total of 500 patients were selected randomly who satisfied the inclusion criteria. Of the total selected patients with infectious diseases, 493 patients (98.6%) received one or more antimicrobials. Use of antimicrobials was high in the age group of ‘6 months to 3 years’, ‘rural patients’ constituted 62% and were mostly from ‘Lower Socio-economic status’ (46%). Respiratory diseases constituted 38% of the patients. Fever was the notable symptom in 68.4%. Cephalosporins (48.6%) were the most frequently prescribed class of antimicrobials. Combination of ‘Parenteral therapy followed by oral therapy’ was the preferred route in 92%, and a combination of two antimicrobials was seen in 34.4%. Majority of the patients (81%) were discharged on advice and most of the patients (37.6%) had duration of stay of 7-9 days. 25.8% reported ‘Adverse Drug Reactions’ including predictable and unpredictable reactions.
Conclusions: Antimicrobial prescribing is common in pediatric infectious diseases. As inappropriate usage of systemic antimicrobials was observed, it is essential that appropriate guidelines on the use of systemic antimicrobials are implanted to ensure rational prescribing of antimicrobials.
Powell JR, Cali TJ, Linkwich JA. Inadequately written prescription: As directed’ Prescription Analysed. Journal of American Medical Association. JAMA. 1973; 226(8):999-1000.
Uppal R. Vijaya Rajendran. Drug Utilization Studies, PGI. Bulletin. 1996;20:1-5.
Mohan S, Dharamraj K, Dindial R, Mathur D, Parmasad V, Ramdhanie J, et al. Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies. Annals of Clinical Microbiology and Antimicrobials. 2004 Dec;3(1):11.
Traub R, Wisseman CL. Bulletin of the World Health Organization, Ecological Considerations in Scrub Typhus 2. Vector Species. 1968;39(2):219-30.
Triparthi KD. Antimicrobial Drugs General Consideration. In: K.D Triparthi’s, Essentials of Medical Pharmacology, Jaypee Brothers Medical Publications, 7th Ed.; 2013:688-689.
Gumbo T. Chemotherapy of Infectious Diseases. In: Laurence L. Brunton, Bruce A. Chabner, Bjorn C. Knollmann, Goodman and Gilman’s, The Pharmacological Basis of Therapeutics; 13th Ed; McGraw Hill; 2010:955-968.
Krivoy N, El-Ahal WA, Bar-Lavie Y, Haddad S. Antibiotic prescription and cost patterns in a general intensive care unit. Pharmacy Practice. 2007;5(2):67-73.
Sathwik BS. Drug utilization Evaluation. In G. Parthasarathi, Karin Nyfort-Hansen, Milap C Nahata. A textbook of clinical pharmacy practice: Essential concepts and skills. 2nd Ed. Orient Blackswan Private Limited; 2012;362-375.
Misan GMH. The members of society of hospital pharmacists of Australia. SHPA standards of practice for drug usage evaluation in Australian hospitals. Australia. 1998;2:15.1-15.7.
Müller-Pebody B, Muscat M, Pelle B, Klein BM, Brandt CT, Monnet DL. Increase and change in pattern of hospital antimicrobial use, Denmark, 1997-2001. J Antimicr Chemother. 2004 Dec 1;54(6):1122-6.
Saleem SM. Modified Kuppuswamy scale updated for Year 2018, Paripex. Ind J Resear. March-2018;7(3):1.
Zaki SA. Adverse drug reaction and causality assessment scales. Lung India. Official Organ of Indian Chest Society. 2011;28(2):152-3.