PRESCRIPTION PATTERN AND USE OF ANTIBIOTICS AMONG PEDIATRIC OUT PATIENTS IN RAJSHAHI CITY OF BANGLADESH (original) (raw)
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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 outpatients 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 not clear and legible in 31% prescriptions. A total 1362 drugs were used in this study with an average 3.36 drugs per prescription. However, none of the drugs was prescribed in generic name. Children were highly exposed to antibiotics (66%) than to adults (44%) of which cephalosporin's (30%) and macrolides (14%) were commonly used. Interestingly, non-steroidal anti-inflammatory drugs (NSAIDs) were also highly accounted in children (53%) than to adults (36%). Conclusion: Our results suggested that the prescription information was incomplete and physicians did not follow the standard guideline for drug treatment resulting in polypharmacy and indiscriminate use of antimicrobials irrespective to the age of patients.
Antibiotics are the key drugs for treatment of infections and are among the most commonly prescribed drugs in Pediatrics department. 1 Their indiscriminate use increases the risk of bacterial drug resistance and thus has prompted the need to use antibiotics judiciously in pediatric practice. 2 Studies reported that 50% to 85% of children receive antibiotics in developed and developing countries. 3 Rational antibiotic prescription is very important to avoid multiple drug resistance, treatment failure, noncompliance and increase in cost of treatment. 4 Irrational prescribing is a global problem. The rationality of prescribing pattern is of utmost importance because bad prescribing habits including misuse, overuse and underuse of medicines can lead to unsafe treatment, exacerbation of the disease, health hazards, and economic burden on the patients and wastage of resources. Examples of irrational use of medicines include: poly-pharmacy, inadequate dosage, and use of antimicrobials even for non-bacterial infections, excessive use of injections when oral forms are available and inappropriate, self-medication and noncompliance to dosing regimes. 5
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.
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...
Background: In the last decades, there has been an escalating consumption of antibiotics with the number of antibiotic prescriptions increasing worldwide. Since children are more vulnerable to infectious disease than adults, more antibiotics are prescribed for them. Inappropriate use of antibiotics has resulted in a major increase in the development of multi-drug resistant pathogens with great implication in terms of morbidity, mortality and costs. The objective of this study was to determine the irrational use of antibiotics prescribed for children under the age of 15 years in Mekelle general hospital. Methods: A retrospective cross sectional study was conducted. Four hundred three children ' s prescriptions and corresponding cards which were recorded by the year 2012 were selected by systematic random sampling proportionally from each month in the year. Results: Of all antibiotic prescriptions reviewed, the numbers of outpatient antibiotic prescriptions were 222 (55.1%) while inpatient prescriptions were 181 (44.9%).The predefined antibiotics indicators like percentage of antibiotics prescribed, frequency of route of administration, antibiotics prescribed from Standard treatment guideline, proportion of antibiotics, cost of antibiotics per antibiotics days, incidence and antibiotics utilization ratio were determined and 141(35.1%) were treated with different antibiotics irrationally. Conclusion: The finding of this study indicated that antibiotics were prescribed irrationally. Prescriptions containing one or more antibiotics constituted 73.68% of all prescriptions and around 5.9% of encounters were treated without any diagnosis. T he study has revealed that third generation cephalosporin (ceftriaxone) has been highly prescribed in the study hospital.
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.
Journal of Nepal Paediatric Society, 2018
Introduction: Infectious diseases are one of the most frequent reasons for hospital admission for children and antimicrobials are commonly used to treat them. There is higher prevalence of irrational prescriptions of antimicrobials in such population. This study was conducted to survey the pattern of antimicrobial prescription in Paediatric inpatient. Material and Methods: This was retrospective, descriptive, observational study. The data was collected from prescription records. The paediatric population included in the study was categorised into three age groups. A total of 87 prescriptions were studied and the information was recorded in performa. Data were recorded in MS Excel and Graph Pad Prism version 6 was used for analysis. Results: The number of male child was outnumbered by female child. The average age of the patient on antimicrobial prescription was 5.34 ± 2.18 years. The mean duration of hospital stay was 6.17 ± 2.01 days. The common indications for antimicrobial prescriptions were upper respiratory tract infections, diarrhoeal illness, urinary tract infections, enteric fever, etc. The antimicrobials prescription rate was 1.33. Oral route was found to be commonly used than parenteral route. The generic prescription rate was 33.6%. The most common drug prescribed was ceftriaxone followed by amoxicillin + clavulanic acid, ciprofloxacin, metronidazole and amikacin. The 62.5% of antimicrobials were prescribed from National Essential List of Medicines. Conclusion: This study highlights the prescription pattern of antimicrobial agents in hospitalised Paediatric population in a tertiary care hospital.
Journal of Nepal Paediatric Society
Introduction: Due to complex dosage calculations, requirement and different pharmacokinetics profile of drugs in paediatric population, there is a risk of development of drug resistance due to the excessive and inappropriate use of antibiotics. The aim of this study is to determine the antibiotic prescriptions pattern and analyse the rationale use of antibiotic in paediatric patient. Methods: A prospective observational study was carried out for the period of six months. Data was obtained from the records of paediatric patients between six months to 12 years of age who visited the hospital for febrile illnesses. Appropriateness of the prescriptions was evaluated by considering various parameters like selection of antibiotics (adherence to standard treatment protocols of childhood febrile illnesses), dose, dosage form, route, frequency and duration of antibiotic administration. Quantitative data was analysed in terms of percentage and graphs. Results: One hundred and fifty prescripti...
International Journal of Basic & Clinical Pharmacology, 2014
Background: The pediatric population comprises of 20-25% of the total world population, and numerous acute and chronic diseases can effect this sub population. Antibiotics are among the most frequently prescribed classes of medications for children. Methods: The study is prospective interventional study carried out in the pediatric outpatient of the MIMS for a period of 3 months (September-November 2013+1 month for analysis). Results: Most (84%) children were given single antimicrobial agent and 16% were given more than one antimicrobial or fixed dose combination of the antimicrobial agent. Amoxicillin (48%), erythromycin (20%) and cefixime (16%) were found to be the most frequently used antibiotics. Conclusions: The high percentage of prescriptions involving antimicrobials observed in MIMS requires rational use of antimicrobials and judicious prescribing. It should be followed by the appropriate use of the selected medicine from the NLEM with frequent update of information. The implementation of antibiotic policy and treatment guidelines with periodic assessment of the clinical pharmacologist in the study area is very important in order to monitor the clinical use of these medications.