A Cross-sectional study of prescribing pattern of antimicrobial agents among inpatients of a tertiary healthcare centre
Abstract
Background: Antimicrobial agents are the mainstay of treatment in modern medicine. In view of emerging threat of Antimicrobial Resistance (AMR), there was a requirement aimed at identifying patterns of antimicrobial prescribing. The prescribing pattern of antimicrobial agents (AMAs) among the medicine inpatients of SMS Medical College & Hospital, Jaipur, India was studied. The objectives were to evaluate, monitor and suggest rational prescribing practices.
Methods: This was a cross-sectional study that was done for a period of one year from July 2016 to June 2017. The rationality of antimicrobial drug use was evaluated by analysing the prescriptions.
Results: A total of 400 patients were included in the study. Percentage of indoor patients with one or more AMAs prescribed was 48.75 %. The average number of AMAs prescribed was 1.67. Percentage of AMAs prescribed consistent with the National List of Essentials Medicines (NLEM) was 89.73 %. The average AMAs duration prescribed was found to be 4.24 days. The most commonly prescribed antibacterial agent in medicine in patients was a beta-lactam AMA with 57.29 % of all prescriptions.
Conclusion: AMR is strongly linked to improper antimicrobial use. This study suggests that certain interventions are required to minimise toxicity and lessen the chances of emergence of resistance. It is therefore proposed that there should be continuous education on rational use of drugs among healthcare professionals.
References
Aminov RI. A brief history of the antibiotic era: lessons learned and challenges for the future. Front Microbiol. 2010;1:134.
Kilgour FG. Modern Medicine in Historical Perspective. Bull Med Libr Assoc. 1962;50(1):42–56.
Waksman, S. A. History of the word ‘antibiotic.’ J. Hist. Med. Allied Sci. 1973; 28:284-286.
Chambers HF, General Principles Of Antimicrobial Therapy - Goodman & Gilman's The Pharmacological Basis Of Therapeutics -11th Ed. (2006) Chapter 42.
Adedeji WA. The Treasure Called Antibiotics. Ann Ib Postgrad Med. 2016;14(2):56-57.
Meher BR, Mukharjee D, Udayshankar. A study on antibiotic utilization pattern in a general medicine ward of a tertiary care teaching hospital. Journal of Chemical and Pharmaceutical Research 2014; 6(7): 1847-49.
Remesh A, Salim S, Gayathri AM, Nair U, Retnavally KG. Antibiotics prescribing pattern in the in-patient departments of a tertiary care hospital. Arch Pharma Pract. 2013; 4:71–6.
Kisuule F, Wright S, Barreto J, Zenilman J. Improving antibiotic utilization among hospitalists: a pilot academic detailing project with a public health approach. J Hosp Med 2008; 3 (1) 64- 70.
Kanish Ravika, Gupta Kanchan, Juneja Shivani, Bains HS, Kaushal Sandeep. Prescribing pattern of antibiotics in the department of pediatrics in a tertiary care medical college hospital in Northern India. Asian Journal of Medical Sciences 2014; 5(4): 69-72.
Strengthening Pharmaceutical Systems. 2012. How to Investigate Antimicrobial Use in Hospitals: Selected Indicators. Published for the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems Program. Arlington, VA: Management Sciences for Health.
Davey, P., Brown, E., Fenelon, L. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst. Rev. 2005; 19: CD003543.
Slobodan MJ, Ljiljana MV, Milan RM, Vojislav BC, Irena RK, Zoran NK. An analysis of drug use indicators in primary care health facilities operating in the city of Kragujevac. Prescribing activities in the community in Kragujevac Serbia. 2006; (16): 1-16.
Massele AY, Nsimbi SED, Rimoy G (2001). Prescribing habits in church-owned primary health care facilities in Dar ES Salaam and other Tanzanian Coast regions. East. Afr. Med. J. 2001; 78 (10): 510-4.
Odunsanya OO. Drug use indicators at secondary health care facility in Lagos, Nigeria. J. Commun. Med. Health Care. 2004; 16 (1): 21-4.
Safaeian L, Mahdanian AR, Hashemi-Fesharaki M, Salami S, Kebriaee-Zadeh J, Sadeghian GH. General physicians and prescribing pattern in isfahan, iran. Oman Med J. 2011 May; 26(3):205-206.
Bosu WK, Ofori-Adjei D. An audit of prescribing practices in Health Care Facilities of the Wassa west district of Ghana. West Afr. J. Med. 2000; 19 (4): 298-303.
Otoom S, Batieha A, Hadidi H, Hasan M, Al-Saudi K (2002). Evaluation of drug use in Jordan, using WHO Prescribing indicators. East Mediter.r Health. J. 2002; 8(4-5): 537-43.
Moghadamnia AA, Mirbolooki MR, Aghili MB. General Practitioner prescribing patterns in Babul City Islamic Republic of Iran. East Med. Health. J. 2002; 8 (4-5): 550-5.
Hazra A, Tripathi SK, Alam MS (2000). Prescribing dispensing activities at the health facilities of a non-government organization. National Med J. India. 2000; 13 (14): 177-182.
Al-Yamani A, Khamis F, Al-Zakwani I, Al-Noomani H, Al-Noomani J, Al-Abri S. Patterns of Antimicrobial Prescribing in a Tertiary Care Hospital in Oman. Oman Medical Journal. 2016; 31(1):35-39.
Hooi PY, Yong CM, Cheong I. A study of the appropriateness of antibiotic use in the medical wards of a tertiary teaching hospital in Malaysia. Int J Clin Pract. 2001 May; 55(4):272-4.
Al Shimemeri A, Al Ghadeer H, Memish Z. Antibiotic utilization pattern in a general medical ward of a tertiary medical center in Saudi Arabia. Avicenna J Med 2011 Jul; 1(1):8-11.
Arya SC. Antibiotics prescription in hospitalized patients at a Chinese university hospital. J Infect. 2004; 48: 117-118.
Bosu WK, Ofori Adjei D. Survey of antibiotic prescribing pattern in government health facilities of the Wassa west district of Ghana. East Afr Med J. 1997 Mar; 74(3):138-42.
Essential Drug List 2016. Available from http://rmsc.health.rajasthan. gov.in/content/dam/doitassets/Medical-and-Health-Portal/rajasthan-medical-corporation/pdf/EDL_Rajasthan.pdf
Ferrer R, Artigas A, Suarez D, Palencia E, Levy MM, Arenzana A, Perez XL, Sirvent JM: Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med 2009; 18:861-6.
Standard Treatment Guidelines 2012 –RMSC. Available from http://rmsc.health.rajasthan.gov.in/content/dam/doitassets/Medical-and -Health-Portal/rajasthan-medical-corporation/pdf/Standard%20 Treatment%20Guidelines/Prelims-2012.indd.pdf
National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. 2016. Available from http://pbhealth.gov.in/AMR_guideline 7001495889.pdf
Sharma P, Kapoor B. Study of prescribing pattern for rational drug therapy. Jammu Kashmir Sci 2003; 5:107-9.
Hariharan S, Pillai G, McIntosh D, Bhanji Z, Culmer L, Harper-McIntosh K. Prescribing patterns and utilization of antimicrobial drugs in a tertiary care teaching hospital of a Caribbean developing country. Fundam Clin Pharmacol. 2009; 23: 609–615.
WHO Drug Information. 2008. Available from http://apps.who.int/ medicinedocs/index/assoc/s14883e/s14883e.pdf
GOI. Gazette Notification. 2016. Available from
https://www. mciindia.org/documents/e_Gazette_Amendments/Ethics-08.10.2016.pdf
Ider BE, Clements A, Adams J, Whitby M, Muugolog T. Prevalence of hospital-acquired infections and antibiotic use in two tertiary Mongolian hospitals. J Hosp Infect. 2010; 75: 214–9.
Najmi MH, HafijRA, Khan I, Fazli FR. Prescribing practices: An overview of three teaching hospitals in Pakistan. J Pak Med Assoc.1998 Mar; 48(3):73-7.
Deshmukh VS, Khadke VV, Patil AW, Lohar PS. Study of prescribing pattern of antimicrobial agents in indoor patients of a tertiary care hospital. Int J Basic Clin Pharmacol 2013; 2:281-5.
Van Boeckel, T.P. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet. Infectious diseases 2014; 14(8): 742–50.
WHO. Policy perspectives on medicines: Promoting rational use for medicines: core components. 2002. Available from http://apps.who. int/medicinedocs/en/d/Jh3011e/
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