Antibiotic utilization pattern in the department of surgery in a tertiary care centre in eastern India
DOI:
https://doi.org/10.18203/2349-2902.isj20195126Keywords:
Antibiotic policy, Antibiotic resistance, Antibiotics, Prescription pattern, World health organization indicatorsAbstract
Background: The overuse and volume of antibiotic prescription has been found to correlate to the incidence of bacterial resistance. Clinical audit and education can favourably change antibiotic prescribing patterns among practitioners.
Methods: Prospective cross-sectional prevalence survey carried out in inpatient department (IPD) and outpatient department (OPD) of department of Surgery, Rajendra Institute of Medical Sciences, Ranchi. 200 prescriptions from OPD and 200 case sheets from IPD were randomly selected. Data was analyzed as per WHO outpatient prescribing indicators. ICU patients and patients on anti-tubercular treatment, antifungals etc. were excluded from this study. Data were computed and analyzed using MS Excel.
Results: In the OPD, the average no of drugs per patient was 3.445 of which 17% were injections. 33% of drugs prescribed were antibiotics. Beta-lactams followed by nitroimidazoles were the most common antibiotic class. In the IPD, an average of 2.26 antibiotics per patients was prescribed. 21% of antibiotics were prescribed by a generic name and 196 patients received antibiotic prophylaxis. β-lactams again were the most commonly prescribed antibiotic class with 42.7% (n=193) of total antibiotics prescriptions, Metronidazole (n=101, 22.37%) was the most prescribed antimicrobial agent.
Conclusions: The practice of polypharmacy and high antibiotic prescription rate is a concern in our part of the country. Prescriptions writing in generic name needs to be encouraged. There is an acute need for the development of antibiotics prescribing guidelines in India.
References
Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122(1):262-8.
Gelband H, Molly Miller P, Pant S, Gandra S, Levinson J, Barter D, et al. The state of the world's antibiotics 2015. Wound Heal South Afr. 2015;8(2):30-4.
Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hos Inf. 2008;70:3-10.
Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, et al. Infectious Diseases Society of America. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Inf Dis. 2008;46(2):155-64.
Boucher HW, Talbot GH, Benjamin Jr DK, Bradley J, Guidos RJ, Jones RN, et al. Infectious Diseases Society of America. 10×20 progress development of new drugs active against gram-negative bacilli: an update from the Infectious Diseases Society of America. Clin Inf Dis. 2013;56(12):1685-94.
Colgan R, Powers JH. Appropriate antimicrobial prescribing: approaches that limit antibiotic resistance. Am Family Phys. 2001;64(6).
Ganguly NK, Wattal C, Chandy SJ, Arora SK, Gupta U, Kotwani A. Situation analysis: Antibiotic use and resistance in India. New Delhi: Global Antib Resist Partn. 2011.
Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proceed Nation Acade Sci. 1999;96(3):1152-6.
World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: World Health Organization. 1993.
Rational Pharmaceutical Management plus Program. How to investigate antimicrobial drug use in hospitals: Selected indicators. Working draft published for the US Agency for International Development. Arlington, VA: Management Sciences for Health. 2001.
Hogerzeil HV, Ross-Degnan D, Laing RO, Ofori-Adjei D, Santoso B, Chowdhury AA, et al. Field tests for rational drug use in twelve developing countries. Lancet. 1993;342(8884):1408-10.
Lambert BL, Salmon JW, Stubbings J, Gilomen-Stūdy G, Valuck RJ, Kezlarian K. Factors associated with antibiotic prescribing in a managed care setting: an exploratory investigation. Soci Sci and Medi. 1997;45(12):1767-79.
Vooss AT, Diefenthaeler HS. Evaluation of prescription indicators established by the WHO in Getúlio Vargas-RS. Br J Pharma Sci. 2011;47(2):385-90.
WHO. Using Indicators to Measure Country Pharmaceutical Situations. Available at: http://www.who.int/medicines/publications/WHOTCM2006.2A.pdf. Accessed on 5 October 2015.
WHO. Guide to Drug Financing Mechanisms. 1998. Available at: http://www.apps.who.int/ medicinedocs/en/d/Jh2928e/7.1.2.html. Accessed on 5 October 2015.
Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AFB: The development of standard values for the WHO drug use prescribing indicators. ICUM/EDM/WHO. http://archives.who.int/ prduc2004/rducd/ICIUM_Posters/1. Accessed on 5 October 2015
Holani SN, Chopra D, Rehan HS, Gupta L, Jais M. Prevalence of Antimicrobial Utilization in a Tertiary Care Teaching Hospital. J Basic Clin Pharma. 2017;8:29-33.
