DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20205003

Antibiotic prescription analysis of inpatients in a tertiary care teaching hospital

Jyothsnya Srinivasa, Vijaya Rajendran

Abstract


Background: Antibiotics are one among the commonly prescribed drugs. Patterns of antibiotic resistance widely follows local patterns of antibiotic prescribing and usage. Periodic surveillance of antibiotic prescriptions at regional level are essential to understand and combat antimicrobial resistance. To study the prescribing pattern of antibiotics among inpatients of various specialties in a tertiary care teaching hospital. 

Method: A prospective observational study of prescribing pattern of antibiotics was conducted among inpatients of various specialties in a tertiary care teaching hospital. Antibiotic prescribing data was collected using a semi structured proforma. The data obtained was analyzed and the conclusions were drawn using descriptive analysis.

Results: A total of 1161 prescriptions were collected. 3211 antibiotics were prescribed. Mean average duration of treatment with antibiotics per patient was 11.8 days. Use of 3rd generation cephalosporins, imipenem, piperacillin and vancomycin observed. 75% of antibiotics were prescribed for prophylactic use. Antibiotics prescribed for therapeutic indication were supported by clinical, radiological and other investigations like culture and sensitivity reports.

Conclusions: The present study highlights the use of antibiotics for long duration among admitted patients. Implementation of antimicrobial stewardship program with adherence to standard treatment guidelines is essential to combat antimicrobial resistance.


Keywords


Antibiotic prescribing, Antibiotic resistance, Antibiotic

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References


Million Death Study C, Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010;376(9755):1853-60.

Barbosa TM, Levy SC. The impact of antibiotic use on resistance development and persistence. Drug Resistance Updates. 2000;3:303-11.

Goossens H, Ferech M, Stichele VR, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579-87.

Bruinsma NS, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H. Antimicrobial Drug Use and Resistance in Europe. Emerging Infect Dis. 2008;14(11):1722-30.

World Health Organization. Global action plan on antimicrobial resistance. Geneva, Switzerland, 2015. Available at: http://www.wpro.who.int/entity/ drug_resistance/resources/global_action_plan_eng.pdf. Accessed on 14 October 2019.

O’Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. 2014. Available at: https://amr-review.org/sites/default/files/ AMR%20Review%20Paper%20-%20Tackling%20 a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf. Accessed on 15 October 2019.

Willyard C. The drug-resistant bacteria that pose the greatest health threats. Nature. 2017;543(7643):15.

Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146-55.

Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115(2):462-74.

Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38(12):1706-15.

Marlieke EA, Kraker D, Davey PG, Grundmann H, on behalf of the BURDEN study group. Mortality and Hospital Stay Associated with Resistant Staphylococcus aureus and Escherichia coli Bacteremia: Estimating the Burden of Antibiotic Resistance in Europe. J Plos Med. 2011;8(10).

Kulkarni RA, Kochhar PH, Dargude VA, rajadhyakshya SS, Thatte UM. Patterns of antimicrobial use by surgeons in India. Ind J Surg. 2005;67:308-15.

Herwaldt LA, Cullen JJ, Scholz D. A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated with Postoperative Nosocomial Infections. Infect Control Hospital Epidemiol. 2006;27(12):1291-8.

World Health Organization. How to investigate Drug use in Health Facilities. Selected Drug use Indicators. WHO/DAP/93.1 Geneva: World Health Organisation:1993a. Available at: http://www.apps. who.int/medicinedocs/pdf/s2289e.pdf. Accessed on 09 July 2019.

Rehan HS, Kakkar AK, Goel S. Surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. Int J Infect Control. 2010;6:i2.

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 Antimicrobials. 2003;2:7.

Najmi A, Sadasivam B, Jhaj R, Atal S, Kumar S, Santenna C. A pilot point prevalence study of antimicrobial drugs in indoor patients of a teaching hospital in Central India. J Family Med Prim Care. 2019;8:2212-7.

World Health Organization. Community-based surveillance of antimicrobial use and resistance in resource-constrained settings report on five pilot projects. Geneva: World Health Organization; 2009. Available at: https://www.who.int/medicines/ publications/community_based_may09.pdf. Accessed on 18 October 2019.

Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;6:e619-29.

Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA et al. Global antibiotic consumption 2000 to 2010: An analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14:742-50.

De WK, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T et al. Strategies to enhance rational use of antibiotics in hospital: A guideline by the German society for infectious diseases. Infection. 2016;44:395-439.

Chen YS, Liv YH, Kunin CM, Huang JK, Tsai CC. Use of prophylactic antibiotics in surgery at a Medical centre in southern Taiwan. J Formos Med Assoc. 2002;101:741-8.

Srinivasa J, Swamy S. Analysis of prescriptions for completeness in a tertiary care teaching hospital. Int J Basic Clin Pharmacol. 2020 (in press).

Vishwanathan N, Gandhi IS, Shashindran CH, Adithan C. Drug utilisation study of antimicrobial agents. Indian J Med Res. 1981;74:772-8.

Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V et al. Variations in antibiotic use across India: Multi-centre study through Global point prevalence survey. J Hospital Infect. 2019;103:280-3.