Evaluation of pharmacotherapy in neonatal and pediatric intensive care unit of a south Indian tertiary care hospital: a prospective observational study

Ananth Kashyap S., Balaji M. N., Harsh Angadi, Prashanth S., Basavanna P. L., Hanumanthachar Joshi


Background: Evaluating the pharmacotherapy is essential at neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) to identify and understand pattern and variability in drug use in polypharmacy, also to promote interventions that will improve patient outcomes.

Methods: In our study, we audited pharmacotherapy of 300 neonates and 100 pediatric patients admitted to NICU and PICU from November 2018 to February 2019. WHO-CORE prescribing indicators, WHO-ATC system and WHO-ICD 10th version was used to evaluate pharmacotherapy and to understand the pattern and extent of medication use and to systematically classify drugs and diseases respectively.

Results: A total of 1207 medications containing 34 unique active ingredients were prescribed for 300 neonates with an average of 4.02 (±2.0) drugs per neonate admitted to NICU and the most prescribed drugs were anti-infectives for systemic use 799. A total of 976 medications containing 69 unique active ingredients were prescribed with an average of 9.76 (±3.81) per pediatric patients admitted to PICU with anti-infectives for systemic use 331 tops the list. More than 75% of drugs was prescribed in generic name with 98% constant availability of key drugs at intensive care unit.

Conclusions: This study substantiates the need for reinforcement of institutional antibiotic policies as antibiotics are widely prescribed and there is an increase trend of antibiotic resistance at critical care unit, assessment of WHO core prescribing indicators are reflective of quality care revealing the awareness about strict monitoring of pharmacotherapy.


Pharmacotherapy, NICU, PICU, WHO-CORE indicators

Full Text:



Helms RA, Herfindal ET, Quan DJ, Gourley DR, Bergstrom KA, Beringer PM, et al. Textbook of therapeutics: drug and disease management. Lippincott Williams and Wilkins; 2006:1227-1256.

World Health Organization. Rational use of Medicines. Available at use/en/index.html; 2010. Accessed on 14 October 2018).

Aranda JV, Clarkson S, Collinge JM. Changing pattern of drug utilization in a neonatal intensive care unit. Am J Perinatology. 1983;1(01):28-30.

Shulman MO, Beyene J, Frndova H, Parshuram CS. Quantifying the volume of documented clinical information in critical illness. J Critical Care. 2008;23(2):245-50.

Medernach RL, Logan LK. The growing threat of antibiotic resistance in children. Infectious Disease Clinics. 2018;32(1):1-7.

World Health Organization. Classifications - The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD). Available at Accessed on 26 October 2018.

World Health Organization. Classifications International Classification of Diseases (ICD) Information Sheet. Available at Accessed on 5 November 2018.

Sisay M, Mengistu G, Molla B. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. BMC Health Serv Res. 2017;17:161.

Warrier I, Du W, Natarajan G, Salari V, Aranda J. Patterns of drug utilization in a neonatal intensive care unit. J Clin Pharmacol. 2006;46(4):449-55.

Aamir M, Khan JA, Shakeel F, Shareef R, Shah N. Drug utilization in neonatal setting of Pakistan: focus on unlicensed and off label drug prescribing. BMC Pediatrics. 2018;18(1):242.

Chauthankar SA, Marathe PA, Potey AV, Nanavati RN. Drug utilization in neonatal intensive care unit of a tertiary-care hospital in Mumbai, India. Indian Pediatrics. 2017;54(11):931-4.

Chatterjee S, Mandal A, Lyle N, Mukherjee S, Singh AK. Drug Utilization Study in a Neonatology unit of a Tertiary Care Hospital in Eastern India. Pharmacoepidemiol Drug Saf. 2007;16:1141-5.

Neubert A, Lukas K, Leis T, Dormann H, Brune K, Rascher W. Drug utilization on a preterm and neonatal intensive care unit in Germany: a prospective, cohort-based analysis. European J Clin Pharmacol. 2010;66(1):87.

Kumbhar AV, Halasawadekar NR, Ramanand SJ, Ramanand JB, Patil PT, Shah RD, et al. Drug utilization study in a neonatal intensive care unit of a government tertiary care hospital in Western Maharashtra. Int J Basic Clin Pharmacol. 2018;7(8):1572.

McDonnell C, Hum S, Frndova H, Parshuram CS. Pharmacotherapy in pediatric critical illness. Pediatric Drugs. 2009;11(5):323-31.

Bonati M, Brambilla C, Colombo F, Tognoni G, Bergher C, Bottino S, et al. Early neonatal drug utilization in preterm newborns in neonatal intensive care units. Italian collaborative group on preterm delivery. Developmental Pharmacol Therapeutics. 1988;11(1):1-7.

Grohskopf LA, Huskins WC, Cochran SRL, Levine GL, Goldmann DA, Jarvis WR. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatric Infectious Disease J. 2005;24(9):766-73.

Fonseca SN, Ehrenkranz RA, Baltimore RS. Epidemiology of antibiotic use in a neonatal intensive care unit. Infection Control Hospital Epidemiology. 1994;15(3):156-62.

World Health Organization. The selection and use of essential medicines: report of the WHO Expert Committee, 2017 (including the 20th WHO Model List of Essential Medicines and the 6th Model List of Essential Medicines for Children). World Health Organization; 2017.

Brett A, Bielicki J, Newland JG, Rodrigues F, Schaad UB, Sharland M, et al. Neonatal and Pediatric Antimicrobial Stewardship Programs in Europe Defining the Research Agenda. Pediatric Infectious Disease J. 2013;32(12):456-65.

Reina BE, Claros MAF, Jimenez VMA, Riola OR, Romero MEI, Extremera RA. Drug utilization pattern in children and off-label use of medicines in a pediatric intensive care unit. Medicina Intensiva (English Edition). 2016;40(1):1-8.