Rationality of utilization of antimicrobial agents in medical intensive care unit of a tertiary care hospital
Keywords:Rationality, Antimicrobial agents, Intensive Care Unit, Drug resistance
Background: Patients admitted to intensive care unit receive multiple medications of different pharmacological classes due to various life threatening ailments. This study was conducted to assess the patterns of usage of antimicrobial agents in medical ICU of a tertiary care hospital and to suggest necessary modifications in prescribing patterns to achieve rational therapeutic practices.
Methods: A cross-sectional observational study was carried out at ICU of the tertiary care hospital for 6 months. From the inpatient case record of ICU relevant data on prescription of each patient was collected. The demographic status, disease data and the utilization of different antimicrobial drug classes and individual drugs were analysed.
Results: Of 753 patients admitted in the medical ICU during the study period, 640 consecutive patients were included for analysis. Male to female ratio was 1.45. Mean age was 63.32±17.93 years. Extensive poly-pharmacy (100%) and drugs with non-generic name (73%) noticed among the prescriptions.Average number of drugs per prescription was 12.1±2.13. Penicillins (51.87%) and cephalosporins (45.78%) were most commonly used antimicrobial drug classes. Piperacillin (37.03%), ceftriaxone (33.28%) and levofloxacin (22.5%) were commonly used antimicrobial drugs. A total of 181 prescriptions contained two and 138 contained three antimicrobial drugs. Piperacillin+tazobactam(37.03%) was the most common fixed dose combination noticed.
Conclusions: Overall extensive poly-pharmacy and drugs with non-generic name noticed among the prescriptions. Few interventional programs should be aimed at control of infections, rational antimicrobial drug prescription to minimize adverse drug events, emergence of bacterial resistance and attenuating unnecessary cost.
WHO. The selection of essential drugs. WHO Technical report. 1977;615:36.
Sachdeva PD, Patel BG. Drug utilization studies - scope and future perspectives. Int J Pharm Biol Res. 2010;1:11-7.
Esposito S, Leone S. Antimicrobial treatment for intensive care unit (ICU) infections including the role of the infectious diseases specialist. Int J Antimicrob Agents. 2007;29:494-500.
Lockhart SR, Abramson MA, Beekman SE, Gallagher G, Riedel SR, Diekma DJ, et al. Antimicrobial resistance among gram-negative bacilli as causes of infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol. 2007;45:3352-9.
Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF. Impact of intensive care drug costs: a descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Crit Care Med. 2003;31:17-24.
Curcio DJ. On behaf of the Latin American antibiotic use in intensive care unit group. Antibiotic prescription in intensive care units in Latin America. Rev Argent Microbiol. 2011;43:203-11.
Paterson DL, Rogers BA. How Soon Is Now? The urgent need for randomized, controlled trials evaluating treatment of multidrug-resistant bacterial infection. Clin Infect Dis. 2010;51:1245-7.
Niederman MS. Appropriate use of antimicrobial agents: challenges and strategies for improvement. Crit Care Med. 2003;31:608-16.
Pulcine C, Pradier C, Samat-Long C, Hyvernat H, Bernardin G, Ichai C, et al. Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother. 2006;57:546-50.
The rational use of drugs, report on the conference of experts Nairobi. Sponsored by WHO Geneva; 1985:25-29.
Goossens H. Antibiotic consumption and link to resistance. ClinMicrobiol Infect. 2009;15(Suppl 3):12-5.
MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev. 2005;18(4):638-56.
Harbarth S, Harris AD, Carmeli Y, Samore MH. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis. 2001;33(9):1462-8.
Hanssens Y, Ismaeili BB. Antibiotic prescription pattern in a medicalintensive care unit in Qatar. Saudi Med J. 2005;26:1269-76.
Gendel I, Azzam ZS, Braun E, Levy Y, Krivoy N. Antibioticutilization prevalence: prospective comparison between two medical departments in a tertiary care university hospital. Pharmacoepidemiol Drug Safety. 2004;13:735-9.
Shankar RP, Partha P, Shenoy NK, Easow JM, Brahmadathan KN. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study. Ann Clin Microbiol Antimicrob. 2003;2:7.
Shankar PR, Partha P, Dubey AK, Mishra P, Deshpande VY. Intensive care unit drug utilization in a teaching hospital in Nepal. Kathmandu University Medical Journal. 2005;3:130-7.
Van der Meer JW, Gyssens IC. Quality of antimicrobial drug prescription in hospital. Clin Microbiol Infect. 2001;7Suppl6:12-5.
Bosu WK, Ofori-Adjei D. Survey of antibiotic prescribing pattern in government health facilities of the was a west district of Ghana. East African Medical Journal. 1997;74:139.
Krivoy N, El-Ahal WA, Bar-Lavie Y, Haddad S. Antibiotic prescription and cost patterns in a general intensive care unit. Pharmacy Practice. 2007;5:67-73.
Badar Vandana A, Navale Sanjakumar B. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in Central India. JAPI. 2012;60:20-3.
Suping HU, Xiuheng LIU, Peng Y. Assessment of antibiotic prescription in hospitalised patients at a Chinese University hospital; 2002.
Smythe MA, Melendy S, Jahns B, Dmuchowski C. An explor atory analysis of medication utilization in a medical intensive care unit. Crit Care Med. 1993;21:1319-23.
Stratton CW 4th, Ratner H, Johnston PE, Schaffner W. Focused microbiological surveillance by specific hospital unit: practical application and clinical utility. Clin Ther. 1993;15SupplA:12-20.