Study on antibiotic use among geriatric patients based on anatomical therapeutic classification or defined daily dose methodology and world health organization-essential medicine list access, watch and reserve concept in tertiary care hospital of South India

Authors

  • Subash Senthilkumar Department of Pharmacy, Annamalai University, Chidambaram, Tamil Nadu, India
  • Arun Raaj S. A. Department of Pharmacy, Annamalai University, Chidambaram, Tamil Nadu, India
  • Padmavathi K. Department of Pharmacy, Annamalai University, Chidambaram, Tamil Nadu, India
  • Dhanapal C. K. Department of Pharmacy, Annamalai University, Chidambaram, Tamil Nadu, India
  • Periasamy K. Department of Medicine, Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20202950

Keywords:

Essential medicine list, Antibiotic use, Defined daily dose, Geriatric, World health organization

Abstract

Background: Geriatric patients are more vulnerable to infections and need special consideration on antibiotic use. Resistance to antibiotics among infectious bacteria has developed within a short span. There is a direct correlation between the consumption of antibiotics and the development of resistance. And surprisingly very few literatures were available on antibiotic consumption in geriatric population using defined daily dose (DDD) concept which paved the idea to conduct this study.

Methods: A prospective observational study was carried out from November 2018 to April 2019. A total of 206 prescriptions of elderly patients were included in the study. The antibiotics were categorized by anatomical therapeutic classification (ATC) and DDD indicator/1000 inhabitants/day (DID) was used to figure out antibiotic consumption.

Results: About 25.2% of patients were treated with antibiotics for respiratory tract infections. The patients received antibiotics empirically (53.8%) and without bacteriological investigation (58.73%). The overall consumption of antibiotics was 20.47 DID in which oral antibiotics was (8.5 DID) 42% and parenteral antibiotics (11.8 DID) 58%. Cephalosporins was observed to be the most consumed antibiotics (33.2%), specifically cefotaxime (14.6%) and ceftriaxone (12.6%). Moreover, 54.4% of antibiotics consumed from watch category of World Health Organisation (WHO) essential medicines list (EML) which was completely against WHO standard proportion.

Conclusions: Higher consumption of cephalosporins, which falls into watch category was analysed in geriatric patients. These broad-spectrum antibiotics have high potential to develop antimicrobial resistance. A strict antibiotic policy is needed to be framed that enhance rational prescribing practices in geriatrics.

References

National health profile 14th issue and WHO collaborating centre on family of international classification, 2019. Available at: http://www.cbhidghs. gov.in/. Accessed on 10th January 2020.

Nobili A, Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbid. 2011;1:28-44.

Mandavi, Tiwari P. Profile of pharmacotherapy in elderly Indian patients: preliminary findings. Inter J Risk Saf Med. 2006;18:151-7.

Antibiotics and antibiotics resistance, first edition. Published by John Wiley and Sons, Inc.; 2011. Available at: https://onlinelibrary.wiley.com/doi/book/ 10.1002/9781118075609. Accessed on 3 June 2020.

Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA. 2018;115(15):E3463-E3470.

Cecchini M, Langer J, Slawomirski L. Antimicrobial resistance in G7 countries and beyond-economic issues, policies and options for action. Paris: Organization for Economic Co-operation and Development; 2015. Available at: https://www.bundesgesundheitsministeriu m.de/fileadmin/Dateien/3_Downloads/G/G7/OECD_AMRreport_G7.pdf. Accessed on 11th January 2020.

Global action plan on antimicrobial resistance, 68 World Health Assembly; WHO, Geneva, 2015. Available at: https://www.who.int/publications-detail/global-action-plan-on-antimicrobial-resistance. Accessed on 14th January 2020.

Antimicrobial stewardship programmes in health-care facilities in low-and middle-income countries: a WHO practical toolkit. Available at https://apps.who.int/ iris/bitstream/handle/10665/329404/9789241515481-eng.pdf. Accessed on 14 December 2019.

WHO collaborating centre for drug statistics methodology, guidelines for ATC classification and DDD assignment 2019. Available at: https://www. whocc.no/filearchive/publications/2020_guidelines_web.pdf. Accessed on 10 December 2019.

WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation Geneva: Available at: https://apps.who.int/iris/bitstream/handle/10665/277359/9789241514880-eng.pdf. Accessed on April 12, 2019.

World Health Organization model list of essential medicines, 21st list, 2019. Geneva: Availbale at https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf. Accessed on 11 March 2020.

WHO methodology for point prevalence survey on antibiotic use in hospitals. Geneva: Available at https://apps.who.int/iris/bitstream/handle/10665/280063/WHO-EMP-IAU-2018.01-eng.pdf. Accessed on 20 August 2019.

National treatment guidelines for antimicrobial use in infectious diseases, India; 2016. Available at: http://pbhealth.gov.in/amr_guideline7001495889.pdf. Accessed on 5 April 2019.

Meena DK, Mathaiyan J. Drug utilization research: a review. Int J Basic Clin Pharmacol. 2019;8:354-61.

Zhussupova G, Skvirskaya G, Reshetnikov V, Dragojevic-Simic V, Rancic N, Utepova D, et al. The evaluation of antibiotic consumption at the inpatient level in Kazakhstan from 2011 to 2018. Antibiotic. 2020;9:57.

Jyothsna CS, Nagarajaiah BH, Shiva Kumar KM. Drug utilization pattern in geriatric inpatients of medicine wards at a government tertiary care hospital. Natl J Physiol Pharm Pharmacol. 2019;9(4):320-7.

Ahmad A, Revanker M, Haque I, Pravina A, Ivan R, Dasari R, et al. Study the prescription pattern of antibiotics in the medicine department in a teaching hospital: a descriptive study. Int J Toxicol Pharmacol Res. 2014;6(2):43-6.

Bhaveshaikh N, Sukumaran S, Vyas U. Drug prescribing patterns in elderly patients in a tertiary level hospital. Int J Basic Clin Pharmacol. 2017;6:759-64.

Nayaka SR, Rajeshwari B, Venkatadri TV. Drug utilization pattern in geriatric inpatients of medicine department in a tertiary care teaching hospital. Int J Basic Clin Pharmacol. 2015;4:568-73.

Bist A, Kulkarni GP, Gumma KM. Study of patterns of prescribing antibiotics in geriatric patients admitted to the medical wards in a tertiary care hospital. Int J Basic Clin Pharmacol. 2016;5:155-8.

Chandrasekhar D, Manaparambil H, Parambil JC. Outcome assessment of intervention on appropriateness of antibiotic use among geriatric patients: A prospective interventional study from a tertiary care referral hospital. Clin Epidemiol Global Health. 2019;7(4):536-41.

Tushar BN, Anand SK, Harshal NP. Drug utilization pattern in geriatric patients attending outpatient department at rural tertiary care hospital in Maharashtra. Asian J Pharm Clin Res. 2017;10(2):314-6.

Shinu MJ, Panda BK, Bhosle DG, Soman N. Evaluation of cephalosporins utilization and compliance with reference to the hospital antibiotic policy of an Indian tertiary care hospital. Int J Basic Clin Pharmacol. 2019;8:1044-50.

Baktygul K, Marat B, Ashirali Z, Harun-Or-Rashid MD, Sakamoto J. An assessment of antibiotics prescribed at the secondary health-care level in the Kyrgyz Republic. Nagoya J Med Sci. 2011;73(3-4):157.

Singha J, Chowdhury D, Hazarika H, Krishnatreyya H. Drug utilization studies on antibiotics in the department of medicine (in patient) of Gauhati Medical College and Hospital (GMCH), Guwahati. Int J Pharma Pract Drug Res. 2018;8(1):34-9.

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.

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Published

2020-06-26

How to Cite

Senthilkumar, S., A., A. R. S., K., P., K., D. C., & K., P. (2020). Study on antibiotic use among geriatric patients based on anatomical therapeutic classification or defined daily dose methodology and world health organization-essential medicine list access, watch and reserve concept in tertiary care hospital of South India. International Journal of Basic & Clinical Pharmacology, 9(7), 1106–1113. https://doi.org/10.18203/2319-2003.ijbcp20202950

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Original Research Articles