DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20200723

Antimicrobial prescribing pattern in a tertiary care teaching hospital: a pilot study

Bhagyashri D. Rajopadhye, Sonali H. Palkar, Vijaya A. Pandit, Priti P. Dhande, Mahadevan Kumar, Sanjay K. Lalwani

Abstract


Background: The emergence of antimicrobial resistance is a worldwide challenge threatening to negate the gains made by discovery of antimicrobial agents (AMAs).  Antimicrobial Stewardship Program (ASP) is an important strategy for ensuring appropriate use of AMAs and controlling emergence of antibiotic resistance. Implementation of ASP must start with assessment of the current state of antimicrobial use. This study was therefore conducted to assess the prevalent prescribing patterns in a tertiary care hospital and identify gaps which warrant corrective intervention.

Methods: This prospective pilot study presents analysis of the first 30 Patients from the medicine ward prescribed at least one antimicrobial agent during the two months of study period. Relevant data was collected in AMA record form. Appropriateness of AMAs was analyzed regarding selection as well as administration protocol as per the hospital antibiotic policy.

Results: Out of the 60 AMAs prescribed to these patients, most commonly prescribed were cephalosporins (63.3%), anti-amoebics (26.6%) and macrolides (23.3%). Common diseases involved were urinary tract infection, acute gastroenteritis, sepsis and lower respiratory tract infections.  Use of AMAs was found to be appropriate for the indication in 42 %, dose in 97%, duration 60 %, route 93% and frequency 90 %.

Conclusions: This gap between the appropriate and the actual practice use of AMAs indicates an urgent need of rigorous implementation of ASP in order to avoid emergence of resistance and to conserve the sensitivity to the available AMAs.


Keywords


Antibiotic Stewardship Program, Antimicrobial resistance, Irrational prescribing

Full Text:

PDF

References


Adiveni T, Chandra DS, Sundresh NJ, Kumar BA, Padmini P, Haritha K. Analysing The Rationality of Antibiotics In Comparing The Different Departments In Rmmch. J Biomed Pharmaceut Res. 2013;2(3):74-6.

Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clini Infect Dis. 2008;46(2):155-64.

Bbosa GS, Geoff W, Kyegombe DB, Ogwal-Okeng J. Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A Systematic Review. Health 6. 2014;6(2):171-87.

Centres for Disease Control and Prevention (CDC). Core elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2014. Available at: http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.html. Accessed 12 April 2019

Vanitha M, Vineela M, Benjamin RK. Prescribing pattern of antibiotics in patients attending ENT OPD in a tertiary care hospital. IOSR-JDMS. 2017;16:30-3.

Kulshrestha S, Aggrawal K. Survey of pattern of antimicrobial use in teaching hospital. Ind J Pharmacol. 1984;16(1):395.

Kunin C. Rational use of antibiotics. WHO Drug Info. 1990;4(1):7.

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharma Therapeut. 2015;40(4):277.

Fair RJ, Tor Y. Antibiotics and bacterial resistance in the 21st century. Perspectives Med Chem. 2014;6:PMC-S14459.

Upadhyay DK, Palaian S, Shankar PR, Mishra P. Rational Drug Prescribing and Dispensing in Tertiary Care Teaching Hospital of Western Nepal. J Institute Med. 2008;30:233-8.

Diaz Granados CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control. 2012;40(6):526-9.

Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients a controlled interrupted time series analysis. Infect Control Hospital Epidemiol. 2012;33(4):354-61.

Singh S, Menon VP, Mohamed ZU, Kumar VA, Nampoothiri V, Sudhir S, et al. Implementation and impact of an antimicrobial stewardship program at a tertiary care center in South India. In Open Forum Infect Dis. 2018;6(4):290.

Realyvásquez-Vargas A, Arredondo-Soto K, Carrillo-Gutiérrez T, Ravelo G. Applying the Plan-Do-Check-Act (PDCA) Cycle to Reduce the Defects in the Manufacturing Industry: A Case Study. Appl Sci. 2018; 8(11):2181.

Tolpadi A, Purandare B, Shah J, Iyer S (eds). Antibiotic Policy. 3rd edition. Pune, India: Bharati Hospital & Research Centre; 2017: 1-52.

Farhan AK, Vinod KS, Sanjeevsharma, Preeti SA. Prospective Study on the Antimicrobial Usage in the Medicine Department of a Tertiary Care Teaching Hospital J Clini Diagnos Res. 2013;7(7):1343-6.

Rajalingam B, Alex AS, Godwin A, Cherian C, Cyriac C. Assessment of rational use of antibiotics in a private tertiary care teaching hospital. Ind J Pharma Pract. 2016; 9(1):14-8.

Jokandan SS, Jha DK. A study of prescribing pattern of antibiotic in a tertiary care hospital – an observational study. Int J Pharm Sci Res 2019;10(5):2285-89.

Lee H, Jung D, Yeom JS, Son JS, Jung SI, Kim YS, et al. Evaluation of ceftriaxone utilization at multicenter study. Korean J Int Med. 2009;24(4):374.

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