PATTERNS OF PRESCRIPTION AND ANTIBIOTIC USE AMONG OUTPATIENTS IN A TERTIARY CARE TEACHING HOSPITAL OF BANGLADESH Original Article (original) (raw)
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Excessive antimicrobial use leads to adverse drug effects, thus increased healthcare costs and promoting the emergence of antimicrobial resistance worldwide. The aim of the study was to evaluate the prescription pattern of antibiotics in pediatric outpatients at private hospitals in Rajshahi city of Bangladesh. WHO / INRUD prescribing indicators were used for the analysis of prescription pattern. A total of 329 pediatric prescriptions were analyzed of which 54% male and 46% female. Most of the patients (48%) belongs to the age group of 1 year-6 years. Body weight was not mentioned in 17% of prescriptions , diagnosis was confirmed only in 11% patients and also 11% of children did not take or completed immunization. Among the children born 83% were of caesarian and 17% of normal delivery. The results also indicated that 964 drugs were used by the patients with an average 2.93 per prescription. However, none of the drugs was prescribed in generic name. Interestingly, only 37.24% drugs were prescribed from the national essential drug list. Children were mainly suffering from fever and common cold 50% and pneumonia 12%. In this study, the percentage of prescriptions with antibiotics were 83% of which major classes were cephalosporin 45.27%, β-lactam antibiotics 22.97%, macrolides 18.92% and quinolones 9.46%. Analgesics 16%, vitamins 8%, drugs for acid related disorders 2% and mineral supplements 2% were also prescribed. Cost of antibiotic per prescription was 299.38 taka. This study revealed that the prescription pattern was irrational resulting from an indiscriminate use of antimicrobials irrespective to the age of patients.
International Journal of Pharmacy and Pharmaceutical Sciences
Objective: Irrational drug use increased the risk of adverse drug reactions (ADRs), the emergence of drug resistance and a leading cause of morbidity and mortality worldwide. The study was designed to analyse prescription patterns and antibiotic use among outpatients in a tertiary care teaching hospital in Bangladesh.Methods: This prospective survey was conducted among the out-patients in a district hospital. The prescribed drugs were classified according to Anatomical and Therapeutic Chemical (ATC) classification system. Patient characteristics and drug data were recorded. The prescription pattern was analysed using general drug use indicators according to world health organisation (WHO).Results: A total of 405 prescriptions were analyzed of which 54% of child and 46% of adult prescriptions. The age and body weight of the patients were not mentioned in 30% of child and 62% of adult prescriptions and none of the prescriptions included sex of the patients. Physician’s handwriting was...
Prescribing Practice of Antibiotics for Outpatients in Bangladesh: Rationality Analysis
Background: Antibiotic prescribing practice by physicians has abruptly increased globally due to increase in antibiotic usage and prevalence of drug resistances. Rational prescribing is mandatory to reduce drug resistance. Rationality analysis of prescribing drugs can help to point towards irrationality and can make a consensus among physicians for rational prescribing. Objectives: The aim is to evaluate the pattern of antibiotic prescribing based on rationality, their usages in various disease conditions among different level of private practitioners in Dhaka city. Methods: This observational study was carried out with a self-designed standard questionnaire by manual data collection over a 24 months period (01.01.2016 to 31.12.2017).The data were collected from the patient's prescription and directly interviewing the patients who were prescribed at least one antibiotic during the study period. WHO/INRUD prescribing indicators were used and descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software. Results: A total of 2,000 prescriptions were analyzed during the study period. Extreme aged patients were prescribed more antibiotics. Commonly prescribed antibiotic groups were cephalosporin (36.00%), macrolides (25.50%), quinolones (21.00%), penicillins (7.50%), and metronidazole (10.00%). 55.25% prescriptions had complete information on dosage form, 65% had complete direction for antibiotics use and 66.5% patients were completed full course of antibiotics. Although 81% prescriptions have no clinical test for using antibiotics, even though the percentages of patients disease recovery were 66% and incompliance were 34%. Conclusion: The study pointed a need for national guidelines for the treatment of common diseases to maintain rationality in prescribing antimicrobial agents and a large surveillance on antimicrobial prescribing appropriateness is warranted.
A Study on Antibiotic Prescription Practices at a Tertiary Care Hospital in Punjab
https://www.ijhsr.org/IJHSR\_Vol.10\_Issue.6\_June2020/IJHSR\_Abstract.019.html, 2020
Purpose: To evaluate antibiotic prescription pattern in patients at a tertiary care hospital. Our other objectives were to study the details about antibiotics (class, frequency, route, dose, duration), rectify the errors in the prescription, and evaluate the prescription according to the WHO guidelines. Methods: The study was an observational prospective study having a total number of 126 patients with study duration of 6 months. The in-patient department prescription orders of the patients were studied and data was recorded in the patient profile form. The recorded data were analyzed as per the objective of the study. Results: Out of 126 patients, cephalosporins (43.7%) were the maximum used class of the antibiotic. The most frequent route of administration used was Intravenous (66.7%). Dose and frequency of the drug were written on most of the prescription, but still medication errors were present in 34.9% of the prescriptions. Sensitivity testing was done on 35.7% of patients. Conclusion: There is a critical role of a clinical pharmacist in a tertiary care hospital to reduce the chances of medical errors and promote rationality of the drugs administered.
International Journal of Basic and Clinical Pharmacology
Antibiotics are the most frequently prescribed drugs among hospitalized patients. 1 The prevalence of antibiotic use is very high in India and ranges from 24 to 67%. 2 Recently, Schedule H1 was introduced in India under the existent Drug and Cosmetic Act 1945 by the regulatory agencies to control the irrational prescribing of antibiotics. 3 Irrational antibiotic usage can lead to increased healthcare utilization, morbidity, mortality, adverse drug events and antimicrobial resistance. 4 ABSTRACT Background: Due to increasing resistance to a majority of antimicrobials, it becomes very necessary to teach undergraduate students, the future prescribers, about the judicious and rational use of antimicrobial drugs. The objective of this study was to impart the basic clinical skills to undergraduate MBBS students which will form an integral component of practising rational therapeutics. Methods: A total no of 737 cases were followed up by the 5th semester 2nd Professional MBBS students in the Department of Pharmacology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun from June 2013 to July 2015. Patients were analysed on various WHO drug use indicators like drug formulations, drugs prescribed per prescription, Fixed dose Combinations (FDCs), drugs prescribed from National List of Essential Medicines (NLEM) and drugs prescribed by generic names. Results: A total of 737 prescriptions were analysed. Male: Female ratio was 1.74:1 (63.50%:36.50%). Majority of the patients 218 (29.58%) were in 16-30 years age group. A total of 1205 antimicrobials were prescribed. 304 (25.23%) cephalosporins were most frequent followed by 184(15.27%) penicillins, 176(14.61%) antitubercular drugs, 163(13.53%) nitroimidazoles, 143 (11.87%) fluoroquinolones, 102 (8.46%) aminoglycosides, 29 (2.41%) macrolides, 19 (1.58%) tetracyclines, 12 (1%) carbapenems, 11 (0.91%) antimalarials, 11 (0.91%) antihelminthics, 6 (0.50%) glycopeptides, 4 (0.33%) lincosamides and 41 (3.41%) miscellaneous antimicrobials. Most frequently prescribed antimicrobial was Ceftriaxone which was given in 97 (8.05 %) patients. A total of 424 (35.19%) oral antimicrobials, 777 (64.48%) injectable antimicrobials and 04 (0.33%) local/topical antimicrobial drugs were prescribed. 5.13 drugs per prescription and 1.64 antimicrobials per prescription were prescribed. 2100 (55.56%) drugs were prescribed from National List of Essential Medicine 2015 (NLEM 2015). 1177 (97.68%) antimicrobials were prescribed from NLEM. 1110 (92.12%) antimicrobials were prescribed by brand names. A total of 342 (28.38%); fixed dose combinations of antimicrobials were prescribed. Conclusions: Majority of the prescriptions revealed poly-pharmacy and a very high percentage of drugs were prescribed by their respective brand names. It is only by observing drug utilization patterns, current trends and common errors in prescriptions can be highlighted and rational prescription of antimicrobials can be taught to MBBS students.
Prescribing pattern of antibiotic misuse in a hospital in the north of Iran
Journal of Clinical and Basic Research (JCBR), 2023
Background: Improper prescription of the type, dose, and duration of antibiotics imposes a financial burden on the health system, can cause many side effects for the patient, and can lead to the emergence of drug-resistant bacteria. This study aimed to determine the profile of prescribing antibiotics in different wards of a hospital and compare it with references. Methods: This study was conducted on the recorded information of 342 patients in the emergency, infectious diseases, pulmonary, and surgical wards of Sayad Shirazi Hospital in Gorgan (north of Iran) in 2019-2020. The type, dose, and duration of the prescribed antibiotics were extracted from each patient's file and compared with references. The compatibility and inconsistency of the prescribed antibiotics were identified and analyzed accordingly. Results: A total of 13 types of antibiotics were prescribed for the patients. There was a 43.7% inconsistency in antibiotic prescription with the references. The most prescribed antibiotic was ceftriaxone (25.6%). Ceftriaxone (11.26%), followed by cefazolin (8.30%), had the most inconsistency in prescription. The most inconsistency in total was respectively observed in the pulmonary (47.9%), general surgery (44.8%), emergency (44.4%), and infectious diseases wards (40.6%). No significant difference was observed between the wards in terms of the total inconsistency of prescribed antibiotics with the references (P = 0.692). Conclusion: The most prescribed antibiotic was ceftriaxone. A high percentage of its prescriptions are without indication and are actually prescribed as empiric. Therefore, it is necessary to monitor the prescription of antibiotics in medical centers based on the indications and available evidence.
An audit of prescription for antibiotic in a tertiary care hospital in Kolkata, India
Exploratory Animal and Medical Research, 2012
Antibiotics are most commonly prescribed drugs in tertiary care hospitals; more than 30% of the hospitalised patients were treated with antibiotics. Rational use of antibiotics is very important to ensure the optimum treatment outcomes and to limit the emergence of bacterial resistance. Present study is a hospital based cross-sectional study carried out for a period of three months in different clinical departments of a tertiary care hospital to find out the antibiotics prescribing pattern. Out of total 551 evaluated prescriptions, an antibiotic was prescribed in 45.5% cases. The most commonly prescribed antibiotics were Moxifloxacin 19.5%, Metronidazole 10.4% and Amoxicillin+Cloxacillin 10.2%, broad spectrum antibiotics usage was higher & 87.7% of the antibiotics were prescribed by brand names. The appropriate use of antibiotic is a greatest need of the current situation all over the world. The rising antibiotic resistance is a global problem which is directly related with the irra...
The worldwide rising incidence of superbugs and the associated risk factorscould be country or area specific. A case control study identifying prescription pattern of antibiotics, was conductedin three major cities Dhaka, Rangpur and Dinajpur for a periodof 6 months.A total number of 600 patient's prescription with age of '0' to over '60' years were collected from the from the different Primary Health Care (PHC) facilities during the study period. A total number of 2494 individual medicineswere prescribed in 600 patient'sprescription. In this study,the majority of the patients were female 321 (53.5%) and male 228 (37.83%) patients and the gender of 52 (8.67%) patients were unidentified in the prescription.The average highest prescribed antibiotic among these three cities were in Rangpur 43.82% and followed by the lowest one was Dhaka city (23%). Most commonly prescribed antibiotic class was cephalosporin of whichcefuroxime (22.10%), cefixime (14.98%), ceftriaxone (6%), and cefradine (2.62%). This study revealed that the prescription pattern has irrational result and indiscriminate use of antibiotic irrespective to the age of patients. Moreover most of the cases the patients present condition and diagnosis was missing in the prescription.