A study on prescription analysis and utilization of antibiotics in geriatric in-patients admitted in Shimoga institute of medical sciences tertiary care hospital, Shimoga, Karnataka, India

Nagaraja Prasad S., Shreenivas Revankar, Vedavathi H., Chidanand KN, Jean L. Murray, Harini Manjunath


Background: Geriatrics is concerned with population aged 60 and above. Elderly suffer from various problems of the old age and hence prone to suffer from various adverse effects due to multiple drug use. In this regard rational use of drugs assumes importance. Hence the present study was conducted to study the rationality of prescriptions and utilization of antibiotics in the geriatric age group.

Methods: 126 inpatient prescriptions were chosen and analysed for their rationality according to WHO core drug use indicators. The prescriptions were chosen randomly during the months of July to November 2013 from inpatients at district Mcgann teaching hospital. Descriptive statistics were used to analyse data.

Results: 97% of total drugs prescribed were from essential drug list (EDL). Cephalosporins were the most commonly prescribed group of antibiotics. Respiratory diseases were the maximum cause of admission to the hospital followed by cardiovascular diseases. Prescription by brand name was 57.93% while generic drug prescription was 40.65% of total drugs prescribed. 7.81% of total drugs were prescribed as fixed drug combination average of 6.25 drugs were prescribed per person and 1.39% of prescriptions were illegible.

Conclusions: Most of drugs prescribed were from WHO model list of essential drugs which conforms to WHO rational drug use. Also prescription by generic name has to be emphasized to promote rationality of prescriptions. Antibiotic prescriptions should be preceded by microbiological testing wherever indicated and illegible prescriptions should be prevented at all costs. Adherence to guidelines regarding drug use in the elderly can help in rational drug use in elderly.


Prescription, Geriatric, Antibiotics, EDL, Rational prescribing

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Patridge L, Mangel M. Messages from mortality: the evolution of death rates in the old. Trends Ecol Evol. 1999;14(1):438-42.

Geriatric knowledge today elderly population. Available at http:/

British Geriatric Society-definition-geriatrics. Available at http:/

Madgaonkar CS. Family medicine. A clinical and applied orientation 2nd Ed Jaypee medical publishers (p) ltd; 2015:247.

Public relations bureau-reports-elderly population 2012. Available at http:/

Cho S, Lau SW, Tandon V, Kumi K, Pfuma E, Abernathy D. Geriatric drug evaluation. Where are we now and where should we be in future? Arch Intern Med. 2011;171(10):937-40.

Gupta M, Agarwal M. Understanding medication errors in the elderly. The New Zealand Medical journal. 2013;126:62-70.

Pir Mohammad M, James S, Meakin S, Green C, Scott AK, Walley TJ. Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18,200 patients. BMJ. 2004;329:15.

Samoy LJ , Zed PJ, Wilbur K, Balen RM, Abu-Laban RB, Roberts M. Drug related hospitalizations in a tertiary care internal medicine service of a Canadian hospital; a prospective study. Pharmacotherapy. 2006;26(11):1578-86.

Silverman JB, Stapinski CD, Churchill WW, Neppl C, Bates DW, Gandhi TK. Multifaceted approach to reducing preventable adverse drug events. Am J Health Sys Pharm. 2003;60(6):582-6.

Austin RP. Poly-pharmacy a risk factor in the treatment of type 2 diabetes. Diabetes Spectrum. 2006;19(1):13-6.

Payne RA, Avery AJ. Poly-pharmacy; one of the greatest prescribing challenges in general practice. Br J Gen Pract. 2011;61(583):83-4.

Rochon PA, Gurwitz JH. Optimizing drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315:1096-9.

Gross F. Drug utilization therapy and practice: the present situation in federal republic of Germany. Eur J Clin Pharmacol. 1981;19:387-94.

Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari RB, et al. Study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of western Nepal. Kathmandu Univ Med J. 2006;4:436-43.

World health organization. The rational use of drugs. Report of conference of experts. Nairobi, 25-29 November 1985. Geneva, World Health Organization; 1987.

Shankar PR, Kumar P, Rana MS, Partha P, Upadhay DK, Dubey AK. Morbidity profile and drug utilization in a sub-health post in western Nepal. Calicut Medical Journal 2004;2(4):4.

International network for rational use of drugs (INRUD) and WHO. How to investigate drug use in health facilities. Selected drug use indicators. Geneva: World health organization. 1993;1:1-87.

Zorowitz BJ, Stebelsky LA, Muma BK, Romain TM, Peterson EL. Reduction of high risk polypharmacy drug combinations in patients in a managed care setting. Pharmacotherapy. 2005;25(11):1636-45.

Mackinnon NJ, Hepler CD. Preventable drug related morbidity in older adults. Part 1. Indicator development. J Manag Care Phar. 2002;8(5):365-71.

Ghosh R, Neogi JN, Srivatsava BS, Sen P. Prescribing trends in a teaching hospital in Nepal. Journal of Nepal medical association. 2003;42:346-9.

Joshi MP, Sugimoto T, Santoso B. Geriatric prescribing in the medical wards of a tertiary hospital in Nepal. Pharmacoepidemiology and drug safety 1997;6:417-21.

American geriatric society updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American geriatrics society. 2012;60(4):616-31.

Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. Screening tool for older persons prescriptions and Screening tool to alert doctors to right treatment. Consensus validation. Int J Clin Pharmacol Ther. 2008;42(2):72-83.

Hilmer SN, Mager DE, Simonsick EM, Ling SM, Windham BG, Harris TB, et al. Drug burden index score and functional decline in older people. Am J Med. 2009;122(12):1142-9.

Naughler CT, Bryme C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol. 2000;7(2):103-7.

Shekelle PG, Mac Lean CH, Morton SC, Wenger NS. ACOVE quality indicators. Ann intern Med. 2001;235:653.

Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug fit for the aged. J Am Geriatric Soc. 2009;57:560.