Monitoring of antibiotic use in a primary and a tertiary care hospital (original) (raw)
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A Retrospective Study on Antibiotic Usage in a Tertiary Care Hospital
International Journal of Medical and Biomedical Studies
Antibiotics are one of the most commonly prescribed drugs today. Rational use of antibiotics is therefore extremely important as their injudicious use can adversely affect the patient. Drug Utilization Evaluation (DUE) is a system of ongoing systematic criteria based evaluation of drug that will help to ensure that medicines are used appropriately. It is drug/disease specific and can be structured so that it will assess the actual process of prescribing, dispensing, or administration of drug. The retrospective study was conducted At Pk Das Institute of Medical Sciences, Palakkad, Kerala for a duration of 6 months (February 2017 - January 2018). A source of data includes Patient case sheets &medication charts, nursing charts, culture & sensitivity reports. The inclusion criterion includes Patients aged between 18- 80 year, prescribed with oral and parenteral antibiotics. . On analyzing the gender, male gender (n= 111, 55.5%) were higher in numbers as compared to female counterparts (...
Longitudinal surveillance of antibiotic use in the hospital
QJM, 2001
We evaluated antimicrobial use in our hospital by department, including indications for use, source of infections, use of the microbiology laboratory, and appropriateness of prescribing, in a prospective, comparative, non-interventional study of all patients receiving antimicrobial agents. We excluded departments where antimicrobial use was negligible. The other 19 departments were followed for 3 (n = 4) or 4 (n=15) months, including 2 consecutive months in the spring-summer and either 1 or 2 in the autumn-winter. Antimicrobial therapy was followed from initiation, through possible adaptations, and possible change from intravenous to oral therapy, until discontinuation of treatment. Overall, 6376 antibiotics were given to 2306 patients. Of the surveyed hospitalized patients, 62%"22% received antibiotics, with a range of 4±100% per department. Antibiotics were prescribed for infections acquired in the community (3037 instances, 47%), in the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis continued post-operatively (582, 9%). The most common indications for antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%), prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site infection (319, 5%). Univariate indicators for appropriateness of treatment were: age, department, site of infection, source of infection, antimicrobial drug and serum creatinine (all p-0.001). Forty-nine antimicrobials were prescribed in 279 combinations, 58% as single agent and 42% as drug combinations. Half of all antimicrobial use consisted of four agents: cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin (10.2%), which together accounted for 20% of expenditure on antibiotics. Although use of as many as 53% of antimicrobials (26/49) surveyed was restricted, use in this category accounted for only 29% of all antimicrobial courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and 2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%) than of unrestricted ones (84%, p-0.001). Of 24 571 defined daily doses (DDD) given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21 602 DDDs given intravenously (p-0.001). Antibiotic treatment in our hospital appears to be substantial and increasing, justifying efforts to improve appropriateness of therapy and improve clinical and financial results.
RATIONALE OF ANTIBIOTIC PRESCRIPTION IN PATIENTS VISITING A TERTIARY CARE SOUTH INDIAN HOSPITAL
Asian Journal of Pharmaceutical and Clinical Research Journal, 2021
Objective: Antimicrobials are the class of drugs that are used irrationally in most cases leading to rise in instances of antimicrobial resistance altering the effect of such agents. Antimicrobial resistance has become a critical issue universally nerving the need to monitor the utilization pattern and rationality in prescribing of antibiotics. This helps in selection of most appropriate antibiotic for the specific patient and achieving the goals of the therapy. Methods: A prospective cross-sectional study with a sample size of 600 participants was conducted in department of general medicine of a tertiary care hospital. Inpatients prescribed with antibiotics were included in the study and their case sheets were reviewed to analyzing the prescribing pattern. The medication usage pattern was then assessed for rationality in prescribing was evaluated. The results obtained were statistically analyzed using SPSS Software. Results: It is noted that a more number of males participated and the greatest number of the patients were from the age group of 31-45. The diagnosis found in the majority of the patients was respiratory tract infection followed by others. On scrutinizing the prescriptions, it was noted that cephalosporins and penicillins were most often prescribed, and on an average single, antibiotic was frequently used with the preferred route of administration in most of the prescriptions being injection route. Though many of the antibiotics were prescribed empirically, it was observed that 59% of them were most appropriately dosed and maximum patients that are around 57% were cured from their illnesses. Conclusion: This study provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship programs. The culture and sensitivity testing suggested that the drug resistance was more for most commonly prescribed antibiotics in the hospital. Increased targeted prescribing based on sensitivity tests will bring down the high use of empiric broad-spectrum antibiotic use.
PLoS ONE, 2012
Antibiotic surveillance initiatives are limited in resource-constrained settings. In the present study, a quantitative comparison of antibiotic use rates for suspected infections in 2 hospitals in India was performed using the ''focus of infection'' approach to identify targets for quality improvement in antibiotic prescription patterns in hospitalized patients. Methods: This observational study was carried out in one teaching and one nonteaching hospital. All the patients with suspected bacterial etiology were included. Data on the prescribed antibiotics and the focus of infection were prospectively collected using a structured questionnaire. Each diagnosis was further reviewed and confirmed by an independent consultant. The prescribed antibiotics were coded according to the World Health Organization Anatomic Therapeutic Classification (ATC) index with the defined daily dose (DDD) methodology. Focus-specific DDDs were calculated per hundred patient days (DDD/HPD). Results: A total of 6026 patients were included from 72 participating physicians out of available 75 physicians. Overall antibiotic prescribing was higher by 5 percentage points in the teaching hospital (95%) than in the nonteaching hospital (90%). Quinolones (ciprofloxacin constituting 86% of DDD/HPD) were the highest prescribed class in the teaching hospital, and third-generation cephalosporins (with ceftriaxone and ceftriaxone/sulbactam constituting 40% and 28% of the DDD/ HPD, respectively), in the nonteaching hospital. The targets identified for improvement were the following: longer than recommended duration of prophylaxis and lack of distinction between prophylaxis and therapy among surgical patients; irrational antibiotic prescribing in gastroenteritis; overuse of quinolones and lack of use of penicillin in pneumonia; overuse of quinolones and lack of use of doxycycline and macrolides in genital infections; and overreliance on antibiotics for treating skin and soft tissue infections. Conclusions: Providing a quantitative comparison of antibiotic use rates for suspected infections, using the ''focus of infection'' approach along with the ATC/DDD methodology, appears appropriate for identifying targets for quality improvement with regards to antibiotic prescribing.
AkiNik Publications, 2018
Antibiotics are one of the most effective and frequently used medications in clinical settings. A crosssectional study was conducted to determine the antibiotic Use in the Treatment of Patients Attending at the Primary Health Care Facility. The study was taken at the outpatient department in Upzilla Health Complex Ramgoti; Lakshmipur. A face to face interview was performed to collect data by using semistructured questionnaire and prescription slip. The study was conducted from August through November 2013. A total 200 respondents, the mean age of the respondents was (41.03 12.26) years ranging from 35-50 years and the majority of the respondents are agriculture (50.4%) and home maker (39.1%). Among the respondents majority of the antibiotics prescribed by the patients were females (55.5%) compared to male patients (44.5%). The proportion of the patients treated with anti-microbial drugs (56.0%).Generally, the mean number of anti-microbial drugs being prescribed per patients were 2.8(± 0.9). From this study majority of the patients was suffering from viral fever (36.0%) and respiratory tract infection (30.0%). The highest prescribed antibiotic was penicillin group (42.5%) followed by Cephalosporin group (35.0%), and Tetracycline (32.5%). However (82.0%) of the drugs were prescribed using generic names. The majority of the patients (77.5%) received two or more antimicrobials in combination for their treatments. Among them (16.1%) patients receiving Penicillin and fluoroquinolone drugs followed by Cephalosporin and Metronidazole drugs (14.2%) and (9.0%) patients also receiving Penicillin, Fluoroquinolone and Cotrimoxazole drugs. The evident of high percentages of patients received antimicrobial treatment in oral route (77.0%) and the intravenous route was also the preferred route of administration (11.0%). From this study, Antibiotic prescribed for the major disease groups where Penicillin, Cephalosporin, Macrolide and tetracycline most frequently prescribed in viral fever (21.0%) & Penicillin, Macrolide and Tetracycline are frequently prescribed in COPD disease (17.5%) and also Metronidazole and cephalosporin were most frequently prescribed in the treatment of Dysentery (9.0%). However the study also reveals that (62.5%) patients received their antibiotic from hospital at free of cost. On the basis of key findings of the study, Periodic monitoring and intervention to improve antimicrobial use in the hospital and further research with large sample size was strongly recommended.
Audit of Antibiotic Practices: An Experience from a Tertiary Referral Centre
Indian Journal of Critical Care Medicine, 2019
Aims: To estimate the prevalence of antibiotic de-escalation at admission in patients referred to a tertiary hospital in India. The secondary outcomes were the adequacy of empirical antibiotic therapy and culture positivity rates in the de-escalated group. Materials and methods: A prospective observational study, in a 20-bedded ICU of tertiary care hospital. Patients> 18 years, surviving > 48 hours, were included (June-December 2017). Demographic data, previous cultures, and antibiotics from other hospitals, laboratory parameters in the first 24 hours, and severity of illness were noted. Changes made in antibiotic therapy within 48 hours were recorded. Patients were analyzed into three groups: "No change"-empiric therapy was maintained, "Escalation"-switch to or addition of an antibiotic with a broader spectrum, and "De-escalation"-switch to or interruption of a drug class. Results: The total number of patients eligible was 75. The mean age of the population is 43.38 (SD + 3.4) and groups were comparable in terms of mean SOFA and APACHE 2. The prevalence of de-escalation was 60% at admission. The escalation group consisted of 24%. Sixteen percent patients belonged to no change group. Results showed that 38% of patients were on Carbapenems, dual gram negative was given to 26%, and empirical MRSA coverage was 28% on admission. Conclusion: Our study aims to provide data about actual practices in the Indian scenario. It highlights the generous use of high-end antibiotics in the community. Indian practices are far cry from theoretical teaching and western data. The need for antibiotic stewardship program in our country for both public and private health sectors is the need of the hour.
International Journal of Pharmacy and Pharmaceutical Sciences, 2016
Objective: Conventional need of broad spectrum antibiotics for multiple organ infections in hospital, ensue the problem of resistance. Most of the antibiotic utilization is empirical leading to their irrational prescriptions. Our present study aims in accessing the drug utilization evaluation of antibiotic usage in a tertiary care hospital which helps in accessing rationality that aid in monitoring the drug efficacy, cost constraints and other factors related to patient safety. Methods: A prospective study was conducted for a period of four months from September 2015 to December 2015 in the Medicine department of Viswabarathi Hospital, Kurnool and AP. Results: A total of 210 prescriptions were analyzed. Among the wide range of antibiotics, i.e., 479 antibiotics prescribed, beta-lactams were found in the maximum cases which accounts for more than half of the cases. Little more than half of the prescriptions i.e.51.90% was with two antibiotics, followed by three antibiotic prescriptions. 9.05% prescriptions were with 4-5 antibiotics. Conclusion: Judgmental use of antibiotics will reduce the burden of multi-drug resistance and thereby enabling better patient management and limiting the resultant morbidity and mortality.
Assessment of Antibiotic Use in a Secondary Care Referral Hospital of South India
IOSR Journal of Pharmacy and Biological Sciences, 2014
The emergence of antibiotic resistant bacteria is major problem throughout the world and rational use of antibiotics is therefore very important. Good infection control practice is a critical component for success of such programme. This six months prospective observational study was designed to evaluate the appropriateness of antibiotic use in a secondary care referral hospital of South India. The data of all in patients (n=100) were collected by obtaining a proper consent. Maximum of 52.78% patients had culture sensitivity test being done, which may taken as a indication for being rational. The results revealed that the purpose of antibiotics prescribed was for prophylaxis (15%), empirically (37%) and therapeutically 48%.In the study population (n=49), totally 110 antibiotics were prescribed, 71.88% on dual therapy and 28.12% were on three antibiotics and the mean number of antibiotics prescribed was 2.28. In the overall population, 61.65% were administrated intravenously and 39.35% of oral antibiotics The major organisms identified were E.coli (28.90%) and Amikacin had shown the highest sensitivity in E.coli (86.4%). Totally 31 drugs of antibacterials were listed in National List of Essential Medicine. Out of 31, 15 antibacterials were prescribed in study population.