STUDY OF PRESCRIBING PATTERN OF ANTIMICROBIAL AGENTS IN MEDICINE INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

DUDHE BG; CHAKRAVORTY ASHISH D; MANKAR NN; PISE HN

doi:10.22159/ajpcr.2020.v13i5.36720

Authors

DUDHE BG Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
CHAKRAVORTY ASHISH D Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
MANKAR NN Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
PISE HN Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.

DOI:

https://doi.org/10.22159/ajpcr.2020.v13i5.36720

Keywords:

Antimicrobial agents, Prescription, Drug utilization, Intensive care unit

Abstract

Objective: The objective of the study was to assess the current use of antimicrobial agents (AMAs) and to assess prescription writing as per the WHO guidelines in the medicine intensive care unit (MICU).

Methods: The present study was conducted on admitted patients in MICU of a tertiary care hospital. The demographic and clinical treatment data of patients were collected in specially designed pro forma from the case record form.

Results: Of 400 patients enrolled in the study, 55.50% were male and 44.50% were female. A common indication of AMAs use was infection (61.75%), symptomatic (21.50%), and prophylactic (10.50%) use. In 65% patients, antimicrobial therapy was considered to be rational. The majority of patients have good recovery (61%). Polypharmacy was seen in 89.75% of patients. The average number of drugs prescribed per patient was 8.84±2.55. 1.90±1.20 was average number of AMAs per patient. Commonest AMAs prescribed are ceftriaxone (27.64%), metronidazole, and amoxicillin+clavulanic acid.

Conclusion: This study visibly highlights the practice of polypharmacy, low uses of generic drugs, high usage of antibiotic, and injection. Cephalosporins are the most prescribed AMAs in the ICUs. Remedy of this situation requires regulation, education, awareness, compliance with protocol, and guidelines of AMAs use.

Downloads

Download data is not yet available.

References

Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011;86:156-67.

How to Investigate Antimicrobial Use in Hospitals: Selected Indicators; 2020. Available from: http://www.apps.who.int/medicinedocs/en/m/abstract/Js21031en. [Last accessed on 2020 Jan 18].

Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S, et al. The global threat of antimicrobial resistance: Science for intervention. New Microbes New Infect 2015;6:22-9.

Isturiz RE, Carbon C. Antibiotic use in developing countries. Infect Control Hosp Epidemiol 2000;21:394-7.

Hashemi S, Nasrollah A, Rajabi M. Irrational antibiotic prescribing: A local issue or global concern? EXCLI J 2013;12:384-95.

Barnett ML, Linder JA. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010. JAMA 2014;311:2020-2.

Schmidt ML, Spencer MD, Davidson LE. Patient, provider, and practice characteristics associated with inappropriate antimicrobial prescribing in ambulatory practices. Infect Control Hosp Epidemiol 2018;39:307-15.

Brunton LL, Chabner BA, Knollmann BC. Principles of prescription order writing and patients compliance instructions. In: Brunton LL, editor. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. New York: Pergamon Press Inc.; 2010. p. 1640.

Badar VA, Navale SB. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in central India. J Assoc Physicians India 2012;60:20-3.

Roberts AW, Visconti JA. The rational and irrational use of systemic antimicrobial drugs. Am J Hosp Pharm 1972;29:828-34.

Shankar PR, Partha P, Nagesh S. Prescribing patterns in medical outpatients. Int J Clin Pract 2002;56:549-51.

Patterson HR. The problems of audit and research. J R Coll Gen Pract 1986;36:196.

John LJ, Padmini D, John J, Goido S. Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital. Asian J Pharm Clin Res 2011;4:81-4.

Naikwadi IB, Baig MS, Bhattacharya M. To study the prescription pattern of antibiotics in medicine intensive care unit at tertiary care hospital. Int J Basic Clin Pharmacol 2019;8:738-45.

Anand N, Nayak IM, Advaitha MV, Thaikattil NJ, Kantanavar KA, Anand S. Antimicrobial agents’ utilization and cost pattern in an intensive care unit of a teaching hospital in South India. Indian J Crit Care Med 2016;20:274-9.

Perveen RA, Nasir M, Farha N, Islam MA. Antibiotics in ICU: The challenges of use, cost and response in a tertiary care hospital. Int J Med Res Health Sci 2018;7:94-9.

Smythe MA, Melendy S, Jahns B, Dmuchowski C. An exploratory analysis of medication utilization in a medical intensive care unit. Crit Care Med 1993;21:1319-23.

Srishyla MV, Krishnamurthy M, Nagarani MA, Mary CS, Andrade C, Venkataraman BV. Prescription audit in an Indian hospital setting using the DDD (defined daily dose) concept. Indian J Pharmacol 1994;26:23-8.

Mangrulkar SV, Mangrulkar S, Khair P, Phalke A. Antibiotic use in the intensive care unit. J Assoc Physicians India 2012;60:15-8.

Pandiamunian J, Somasundaram G. A study on prescribing pattern of anti microbial agents in the medical intensive care unit of a tertiary care teaching hospital in Puducherry union territory, South India. Int J Pharm Sci 2014;6:235-8.

Nikhilesh A, Nagendra IM, Advaitha MV, Noble JT, Kiran A, Kantanavar KA, et al. Antimicrobial agents’ utilization and cost pattern in an intensive care unit of a teaching hospital in South India. Indian J Crit Care Med 2016;20:274-9.

Shankar PR, Partha P, Dubey AK, Mishra P, Deshpande VY. Intensive care unit drug utilization in a teaching hospital in Nepal. Kathmandu Univ Med J (KUMJ) 2005;3:130-7.

Williams A, Mathai AS, Phillips AS. Antibiotic prescription patterns at admission into a tertiary level intensive care unit in Northern India. J Pharm Bioallied Sci 2011;3:531-6.

Alamchandani RR, Khubchandani PR. A study evaluating appropriateness of utilization pattern of antimicrobials in patients admitted in medical intensive care unit of tertiary care teaching rural hospital. Int J Pharm Pharm Sci 2015;7:101-4.

Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63:187-95.

Kutty KV, Narmadha S, Nagarajan M. A study on drug prescribing pattern in Madurai city. Indian J Pharmacol 2002;34:361-2.

Curcio D. Antibiotic prescriptions in critically-ill patients: A Latin American experience. Ann Med Health Sci Res 2013;3:220-8.

Amit GS. Drug use evaluation study in a tertiary care corporate hospital with special reference to use of antibiotics in ICU department. Int J Adv Pharm Biol Chem 2013;2:179-89.

Admane PD, Hiware SK, Mahatme MS, Dudhgaonkar SD, Deshmukh SN, Mahajan MM. Prescription pattern of antimicrobials in tertiary care hospital in central India. Int J Pharmacol Res 2015;5:31-4.

Alharafsheh A, Alsheikh M, Ali S, Baraiki AA, Alharbi G, Alhabshi T, et al. A retrospective cross-sectional study of antibiotics prescribing patterns in admitted patients at a tertiary care setting in the KSA. Int J Health Sci 2018;12:67-71.

Jana SK, Mondal P, Bhattacharya SK. A historical perspective on the rational use of drugs (RUD) in India. Indian J Pharmacol 2006;38:374-5.

Jokandan SS, Jha DK. A study of prescribing pattern of antibiotics in a tertiary care hospital-an observational study. Int J Pharm Sci Res 2019;10:2285-89.

Hanssens Y, Ismaeili BB, Kamha AA, Elshafie SS, Adheir FS, Saleh TM, et al. Antibiotic prescription pattern in a medical intensive care unit in Qatar. Saudi Med J 2005;26:1269-76.

Gowthami B, Spurthi T, Afreen SS. Drug utilization evaluation of antibiotics in general medicine department of a tertiary care hospital. Int J Pharm Pharm Sci 2016;8:302-4.

Usluer G, Ozgunes I, Leblebicioglu H. A multicenter point prevalence study: Antimicrobial prescription frequencies in hospitalized patients in Turkey. Ann Clin Microbiol Antimicrob 2005;4:16.

Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol 2006;46:945-51.

Shankar RP, Partha P, Shenoy NK, Easow JM, Brahmadathan KN. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the internal medicine ward of a teaching hospital in Western Nepal: A prospective study. Ann Clin Microbiol Antimicrob 2003;2:7.

Maharani B, Jafrin AL, Prakash M, Priyadarshini P. Prescription pattern of patients admitted in the intensive care unit of a tertiary care hospital in Puducherry, India: A cross sectional study. Int J Basic Clin Pharmacol 2017;6:2822-26.