Study of prescription pattern of antimicrobials used in post-operative surgical patients in tertiary care hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20212068Keywords:
Surgical site infections, Clean, Clean contaminated, Dirty woundsAbstract
Background: Antimicrobials are used for prophylaxis and treatment of infections which occur following surgical procedures, to reduce the morbidity and mortality associated with surgical site infections (SSIs). A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. These are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure.
Methods: A prospective, non-interventional, observational study in tertiary care hospital for duration of 9 months. Sample size was 330.
Results: The prescription pattern shows that nitroimidazoles were the most commonly prescribed group of antimicrobials in 72% of patients followed by penicillins (58%) and cephalosporins (42%). Metronidazole (72%), amoxicillin and clavulanic acid (51.21%) ceftriaxone (20.90%) were most commonly prescribed antimicrobials in these groups. Two antimicrobials were prescribed in 47% patients with nitroimidazole and penicillins being the most commonly prescribed combination of antimicrobial. Three antimicrobials were prescribed in 25% patients and four antimicrobials in 8% patients. This shows trend towards polypharmacy. About 82% of antimicrobials were prescribed by brand names and 64% of total antimicrobials prescribed from outside the hospital pharmacy source. About 12.42% of patients changed antimicrobial therapy after culture and sensitivity report.
Conclusions: Total duration, number of anti-microbial used was more in clean-contaminated, contaminated, dirty wound surgeries as compare to clean wound surgeries. Our study provides a framework for continuous prescription audit of antimicrobials in a hospital setting and thus can help in rational use of antimicrobials in post-operative surgical patients.
References
Bulander RE, Dunn DL, Beilman GJ. Surgical Infections. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Kao LS, Hunter JG, Matthews JB, eds. Schwartz Principles of Surgery. 11th ed. USA: McGraw-Hill; 2019: 157-182.
Lamont P. Surgical infection. In: Williams NS, Andrew W, McCaskie, eds. Bailey and Love Short Practice of Surgery. 27th ed. London: Hodder Arnold; 2018: 42-56.
Lampiris HW, Maddix DS. Clinical Use of Antimicrobial Agents. In: Katzung BG, Susan B, Trevor AJ, eds. Basics and clinical pharmacology. 11th ed. USA: McGraw-Hill; 2009:895- 898.
World Health Organization. Introduction to drug utilization research. National Institute of Food and Drug Safety Evaluation in Republic of Korea; 2003.
William AP. Penicillins, Cephalosporins, and Other β-Lactam Antibiotics. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman & Gilman’s Pharmacological Basis of therapeutics. 13th edn. USA: McGraw-Hill; 2010: 1477-1503.
Kulshretha S, Aggrawal KK. Survey of pattern of antimicrobial use in teaching hospital. Indian J Pharmacol. 2010;16(1):395.
Creative Research Systems. Sample Size Calculator, 1982. Available at: https://www.surveysystem.com/ sscalc.htm. Accessed on 7 March 2021.
Chawda HM, Patel M, Mandaviya D, Barvaliya M, Patel T, Tripathi DC. Utilization pattern of antimicrobials among patients undergone midline laparotomy in four tertiary care teaching hospitals of Gujarat, India: multi-centric retrospective study. Asian J Pharm Clin Res. 2013;6(5):145-50.
Allen G, Fapic C. New CDC guideline for the prevention of surgical site infections. Am Nurse Today. 2017;12(8):6-10.
National Centre for Disease Control. National treatment guidelines for antimicrobial use in infectious diseases. 2016: 1-64.
Kamath SG, Varun HV, Rani UD, Aithal S, Patil UN. Prescribing patterns of antimicrobials in surgical departments in a tertiary care hospital in South India. Orthopaedics. 2014;44:28-57.
Brethis CS, Thamizharasan S, Sridevi SA, Kalaiselvi B, Singh MB, Vijaykumar K. A prospective study of the pattern of use of antimicrobial agents in surgical prophylaxis in a tertiary care centre. Int J Pharm Pharm Sci. 2017;9(1):283-7.
Sharma N, Bhargava M, Mahawar D, Parakh R. Usage of antibiotics in postoperative patients in a tertiary care teaching hospital in India. Internat J Pharm Res Bio-Sci. 2014;3(2):99-105.
Sharma P, Goel D. Utilization Assessment of antimicrobial prophylaxis in surgical patients at tertiary care hospital. Saudi J Health Sci. 2018;7:23-7.