Trend analysis of antibiotics consumption using WHO AWaRe classification in tertiary care hospital

Authors

  • Ankit Bhardwaj Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India
  • Kaveri Kapoor Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India
  • Vivek Singh Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20204493

Keywords:

Antibiotics, AWaRe classification, ATC Classification, Defined daily dose

Abstract

Background: Aim of the study was to assess trend in antibiotics consumption pattern from 2016 to 2019 using AWaRe classification, ATC and Defined daily dose methodology (DDD) in a tertiary care hospital. Antibiotics are crucial for treating infectious diseases and have significantly improved the prognosis of patients with infectious diseases, reducing morbidity and mortality. The aim of the study is to classify the antibiotic based on WHO AWaRe classification and compare their four-year consumption trends. The study was conducted at a tertiary care center, Pilakhuwa, Hapur. Antibiotic procurement data for a period of 4 years (2016-2019) was collected from the Central medical store.

Methods: This is a retrospective time series analysis of systemic antibiotics with no intervention at patient level. Antibiotic procurement was taken as proxy for consumption assuming that same has been used.  ATC for systemic use (ATC code J01) antibacterial was used and defined daily dose (DDD) per 100 bed days was calculated. Antibiotics were further classified as Access, Watch, and Reserve (WHO AWaRe classification).  Antibiotics consumption was ranked based on their volume of DDD i.e., drug utilization (DU90%) was calculated. Non-parametric Pearson’s correlation coefficient was used for the comparison of consumption.

Results: Mean antibiotic procurement increased 1.25 folds from 140.3 DDD in 2016 to 201 DDD in 2018. A significant fall was seen in total DDDs in year 2019 (p value <0.05). A total of 41 antibiotics agents (Access 12, Watch 21, Reserve 6 and Not recommended 2) were procured. Reserve category antibiotics were procured from 2017 onwards. Out of 41 antibiotics procured 11 antibiotics (Access 3 and watch 8) accounted for DU 90%.

Conclusions: Antibiotics consumption of watch group was high and increasing antibiotic consumption trend was observed. Hospital antimicrobial stewardship program should be implemented to shift to use of Access group antibiotics and restrict use of Watch antibiotics.

Author Biography

Ankit Bhardwaj, Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India

Senior Resident 2nd-year

Dept of neuropsychopharmacology

Institue of human behavior and allied sciences, Shahdara. 

References

Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic procurement between 2000 and 2015. Proc Natl Acad Sci. 2018:201717295.

McElnay JC, Scott MG, Sidara JY, Kearney P. Audit of antibiotic usage in a medium-sized general hospital over an 11-year period. The impact of antibiotic policies. Pharm World Sci. 1995;17:207–13.

MacDougall C, Polk RE. Antimicrobial stewardship programs in health care sys-tems. Clan Microbial Rev. 2005;18:638–56.

Sharland M, Pulcini C, Harbarth S, Zeng M, Gandra S, Mathur S, Magrini N. Classifying antibiotics in the WHO essential medicines list for optimal use—be AWaRe. Lanc Infect Dis. 2018;18(1):18–20

Handyal H, Kumar G, Chowdary PA, Jayasree V, Rathinavelu MR. Drug utilization research of antibiotics in an intensive care unit: a retrospective study from a rural healthcare setting in south india. Int J Scientif Resear. 2019;8(5):2019

Gidamudi SS, Jadhav SA, Khanwelkar CC, Thorat VM, Desai RR, Naik HG. Drug utilization study on antimicrobial use in urinary tract infection. Nation J Medic Resear. 2015;5(3):216-21.

Sharma A, Oommen S. Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection. Int J Basic Clin Pharmacol 2018;7:363-9.

World Health Organization. WHO Report on Surveillance of Antibiotic Procurement: 2016-2018 early Implementations. Available at: https://www.who.int/medicines/areas/rational_use/oms-amr-amc-report-2016-2018/en/. Accessed on 20 May 2020.

World Health Organization. Aware Portal. Available from: https://adoptaware.org. Accessed on 25 May 2020.

Hsia Y, Sharland M, Jackson C, Wong IC, Magrini N, Bielicki JA. Procurement of oral antibiotic formulations for young children according to the WHO access, watch, reserve (AWaRe) antibiotic groups: An analysis of sales data from 70 middle-income and high-income countries. Lancet Infect Dis. 2019;19:67-75.

Kuster SP, Ruef C, Bollinger AK, Ledergerber B, Hintermann A, Deplazes C, et al. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother. 2008;62(4):837-42.

Gandra S, Kotwani A. Need to improve availability of “access” group antibiotics and reduce the use of “watch” group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance. J of Pharm Policy and Pract. 2019;12:20.

Barker AK, Brown K, Ahsan M, Sengupta S, Safdar N. Social determinants of antibiotic misuse: a qualitative study of community members in Haryana, India. BMC Pub Heal. 2017;17(1):333.

Walia K, Madhumathi J, Veeraraghavan B, Chakrabarti A, Kapil A, Ray P, et al. Establishing antimicrobial resistance surveillance & research network in India: journey so far. Ind J Medic Resear. 2019;149(2):164.

Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008–2014. Int J Infect Diseas. 2016;50:75-82.

Goel N, Wattal C, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Trend analysis of antimicrobial procurement and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India. J Antimicrob Chemother. 2011;66(7):1625-30.

Shankar PR, Hassali MA, Shahwani NA, Iqbal Q, Anwar M, Saleem F. Responsible use of fixed-dose combination antibiotics in India. Lanc Glob Heal. 2016;4(10):e689.

WHO. Medicines. WHO releases the 2019 AWaRe Classification Antibiotics. Available at: https://www.who.int/medicines/news/2019/WHO_releases2019AWaRe_classification_antibiotics/en/. Accessed on 05 May 2020.

NCDC. Index 1. National Programme on Containment of Anti-Microbial Resistance (AMR). Available at: https://ncdc.gov.in/index1.php. Accessed on 07 May 2020.

Downloads

Published

2020-10-21

How to Cite

Bhardwaj, A., Kapoor, K., & Singh, V. (2020). Trend analysis of antibiotics consumption using WHO AWaRe classification in tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 9(11), 1675–1680. https://doi.org/10.18203/2319-2003.ijbcp20204493

Issue

Section

Original Research Articles