Drug Utilization Evaluation of Antibiotics in a Tertiary Care Centre, Bhubaneswar
1Rajesh Kumar Lenka, 2Jatindra NathMohanty*, 2Swayamprabha Sahoo
1Department of Microbiology, IMS and SUM Hospital, SOA deemed to be University, Bhubaneswar, Orissa, India.
2Medical Research Laboratory, IMS and SUM Hospital, SOA deemed to be University, Bhubaneswar, Orissa, India.
Corresponding Author
Dr. Jatindra Nath Mohanty, Assistant Professor, Medical Research Laboratory, IMS and SUM Hospital, SOA deemed to be University, Bhubaneswar-751003, Odisha, India.
Email Id- [email protected]
Abstract
The conventional need for broad-spectrum antibiotics for inorganic infections in hospitals raises the problem of resistance. Most antibiotic use is empirical and results in irrational prescriptions. Our current study aims to gain access to an assessment of drug use for antibiotic use in tertiary hospitals that will facilitate access to rationality and facilitate monitoring of drug effectiveness, cost constraints and other related factors in patient safety.
The prospective study was conducted at IMS and SUM Hospital, Bhubaneswar for a period of one year May 2019 to April 2020. A total of 420 cases were analyzed. Among the wide variety of antibiotics, viz. Of the 479 antibiotics prescribed, beta-lactam was detected in maximal cases, that is, more than half of cases. 51.90% received two antibiotics followed by three antibiotic prescriptions. 9.05% of prescriptions are given with 4-5 antibiotics. Careful use of antibiotics will reduce the severity of multiple drug resistance, thus allowing better patient management and limiting the resulting morbidity and mortality.
Key words: Infection, Prescription, Rationality, Antibiotics, Mortality
Introduction
Infection is the main cause of the poor prognosis of the disease. Therefore, proper infection control can avoid or prevent certain situations that cause morbidity or mortality. Infection control can be done through the use of antibiotics. Like a coin, it has two sides; Antibiotics also have bilateral effects. Control infection; another one is body resistance. The problem of resistance has been growing for a decade. This has led to the use of fixed dose combinations, the use of multiple antibiotics to control the infection well. Various studies on the use of antibiotics have been conducted, but mostly in developed countries, with very little data added for Eastern India. The doctor's accidental administration of antibiotics for multi-organ infections does not provide a clear picture of the percentage of a particular class of antibiotics in a prescription that reflects this irrationality. This study helps address some of these problems. Certain guidelines for rational antibiotic use have been established. Despite these guidelines, many doctors prescribe antibiotics irrationally. In current trends, antibiotics make up the bulk of prescriptions. Studies conducted by many experts show that almost every prescription contains antibiotics [1]. Some guidelines for rational antibiotic use are as
follows: Prophylactic and empirical antibiotic therapy should only be used when and in urgent cases, culture-sensitive antibiotic testing must be performed to avoid resistance.
Antibiotics should be prescribed according to the antibiotic range. The antibiotic dose must be according to the patient's condition. Gradual increase in dose should be carried out if efficacy is not observed. Parenteral care is recommended unless necessary (if the patient is unable to take it orally or in an emergency). Following the guidelines above will minimize the effect on the drug. Drug use assessment is a means to increase the rationality of prescribing, namely; help monitor drug effectiveness, cost constraints, and other factors related to patient safety [2]. It also plays a key role in minimizing adverse drug effects [3].So taking these realities our point here is the medication use design for setting suitable intercessions to distinguish the issues in prescribing practices and also in promoting rational use of medicine in the society.
Material and methods
Our current prospective study of antibiotic use aims to examine drug use patterns to identify appropriate interventions to identify problems in prescribing practice and promote rational drug use in society. The current novelty of this study is that it determines the use of antibiotics in the hospital and thus the preventive measures prescribed by the health worker, which increases the rationality and the individual treatment regimen. The study was conducted for 1 complete year from May 2019 to April 2020. This study included hospital patients who were admitted to the medical department for various diseases. A patient who met the following criteria was included, with the inclusion criteria being a patient <80 years of age of both sexes. The exclusion criteria were patients with diseases such as psychiatry, cancer, pregnant and lactating women. Cases found in the medical department, case details including patient name, age, gender, medical history and other relevant information were collected. The collected prescriptions are entered into a Microsoft Office Excel worksheet according to age, gender, therapy category and prescription. The study protocol was approved by the Institutional ethical Committee and patient consent was obtained.
Results
A total of 420 recipes were analyzed. Of the prescriptions collected, 256 (60.95%) were male and 164 (39.05%) female. Among the frequently collected prescriptions, age was calculated by dividing the four age groups by 20 years. The maximum number of patients was found in the 21-40 year age group, the smallest in the 0-20 year group (Table 1, 2).
Table 1: Distribution by gender
Sl. No No of prescriptions percentage
Males 256 60.95%
Females 164 39.05%
Total 420 100
Table 2: Age-wise distribution of patients
Age(y) No. of prescriptions Percentage
0-20 72 17.14%
21-40 140 33.34%
41-60 124 29.52%
61-80 84 20%
Total 420 100
Table 3: According to drug class, drugs prescribed
Drug class Drug
Pencillins,cephalosporins,and other beta- lactams(276)
Aminoglycosides(3) Tetracycline(17) Quinolones(58)
Macrolides(25) Anti malarials(32) Anti mycobacterials(51)
Ceftriaxone Cefperazone Cefotaxime Cefixime Meropenem Imipenem Aztreonam Amoxicillin Piperacillin Amikacin Metronidazole Linezolid Tetracycline Doxycycline Ciprofloxacin Ofloxacin Moxifloxacin Clarithromycin Clindamycin Azithromycin Anti malarials Artesunate Quinine Rifampicin Pyrazinamide Ethambutol Isoniazide No of antibiotic prescribed in each patients are in below table
Table 4: No of antibiotic prescribed in each patient
Sl No Categories No of prescription Percentage
1 Single antibiotics 74 17.62%
2 Double antibiotics 218 51.90%
3 Triple antibiotics 90 21.43%
4 More than 3 antibotics 38 9.05
In the prescription collected 51.90%, that is. More than half of the prescriptions were for two antibiotics, followed by three antibiotic prescriptions. 9.05% of prescriptions are given with 4-5 antibiotics.
Discussion
Research into drug use patterns is growing rapidly because of the irrationality of prescriptions. Irrationality is the main source of resistance. Prevention of resistance and rationality can be improved by prescribing the lowest possible antibiotic dose for the shortest possible duration with the least economic considerations [4]. The duration of therapy or treatment with antibiotics should follow standard treatment guidelines. Over-the-counter or over-the-counter antibiotics can cause treatment failure or side effects. Drug use assessment is therefore a tool for accessing the rationality of prescription [1].
One from Meher B. R et al. The studies conducted indicated the majority of patients were male, which is in line with our study [5]. Our current research shows that antibiotic prescription is primarily for the 21 to 40 year age group. Puducherry demonstrated that antibiotic prescription was maximal in the 51-60 age group [6]. Beta-lactams and quinolones are usually antimicrobials. Among beta-lactams, cephalosporins, especially Generation III, are at the top. This is related to the research of Lisha Jenny John et al. Para, where cephalosporins and aminoglycosides were observed [7]. One of the MujtabaHussainNaqvi Syed et al. The study conducted showed that more than half of the patients enrolled in the study received one antibiotic, followed by two antibiotic applications [8]. This contradicts our study, where mainly two antibiotic applications were observed, followed by three drug applications [9, 10].
Beta-lactams and quinolones were the ordinarily endorsed antimicrobial classes. Among beta–lactams, cephalosporins explicitly III ages were on the top. This hushes up in relationship to the investigation led by Lisha Jenny John et.al. In which cephalosporins and aminoglycosides are seen [7] .An examination led by MujtabaHussainNaqvi Syed and others shown that the greater part of the patients taken into the investigation were with a solitary anti-microbial followed by two anti-toxin uses. This was discovered opposing with our investigation where two anti-toxin uses were found in major followed by three medication use [8].The present examination broke down the antimicrobial medication usage of patients conceded to the clinical division of the hospital setting. The motivation behind inpatient based solution review has the benefit of limiting the 'quitters' as patients needed to buy and ingest the recommended medications and restriction of the investigation was a subjective appraisal of antimicrobial medication usage was not performed.
At long last, we infer that that careful and prudent utilization of antimicrobials will decrease the weight of multi-drug obstruction and along these lines enabling better patient administration and limiting the resultant dreariness and mortality. This will help in justifying endorsing rehearses dependent on the input from these examinations and practices between foundations, locales and nations can measure up
Conclusion
This study analyzed the use of antimicrobial drugs in patients treated in the medical department of a hospital. The goal of inpatient prescription testing has the advantage of minimizing early school graduation, because patients have to buy and use prescription drugs and the research is limited to a qualitative assessment of the use of antimicrobial agents.
Finally, we conclude that the prudent and prudent use of antibiotics will reduce the severity of multiple drug resistance, thus enabling better patient management and reducing the resulting morbidity and mortality. This will help streamline prescribing practices based on feedback from this study and to compare practices across agencies, regions and countries.
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