PRESCRIBING PATTERNS OF CEPHALOSPORIN IN CHILDREN FOLLOWING IMPLEMENTATION OF ANTIBIOTIC STEWARDSHIP PROGRAM IN A TERTIARY CARE HOSPITAL AT WESTERN INDIA
Objective: The objective of the study was to study the prescribing patterns of cephalosporins in children following the implementation of Antibiotic Stewardship Program (ASP) in a tertiary care hospital at western India.
Methods: This was an observational study of records using data of pre- and post-implementation of ASP. Data were collected from case files of children admitted to pediatric wards in the years 2012 and 2014, respectively. Data were analyzed to find the prescribing pattern of cephalosporin and its appropriateness in relation to ASP program guidelines.
Results: Three hundred case files were collected and analyzed (n=150 each from the year 2012 and 2014). The mean age of patients in both years was 6.21 years±5.63 (the year 2012) and 5.88 years±5.88 in (the year 2014). Majority of children, that is, 47.3% were suffering from infectious diseases in the year 2012 while in the year 2014, 38.7% suffered from infectious diseases. Post-implementation of ASP, there was an improvement in the appropriateness of cephalosporin prescribing in terms of prophylactic and empirical treatments. Switch over of parenteral cephalosporins to oral was observed in 54.0% patients in 2012, while in 2014, it was seen in 51.3% of patients. There was a 4.6% rise in prescriptions containing 1st generation cephalosporins. Overall there was a significant impact of ASP in terms of appropriate cephalosporin prescribing (p=0.039).
Conclusion: Implementation of ASP and its adherence by pediatricians can improve antibiotic prescribing in children.
2. Walson PD. Pediatric clinical pharmacology and therapeutics. In: Speight TM, Holford NH, editors. Avery’s Drug Treatment. Auckland, New Zealand: Adis International; 1997. p. 127-223.
3. Reddy NS, Kejiya G, Lakshmi P, Manohar B, Ranganayakulu D. Evaluation of cephalosporins use among pediatric in-patients at Tertiary care teaching hospital. Int J Inst Pharm Life Sci 2015;5:85-94.
4. Remesh A, Retnavally K, Salim S, Gayathri AM. Antibiotics prescribing pattern in the in-patie t departments of a tertiary care hospital. Arch Pharm Pract 2013;4:71.
5. Cosgrove SE, Kaye KS, Eliopoulous GM, Carmeli Y. Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species. Arch Intern Med 2002;162:185.
6. Macdougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005;18:638-56.
7. Chandy SJ, Michael JS, Veeraraghavan B, Abraham OC, Bachhav SS, Kshirsagar NA. ICMR program on antibiotic stewardship, prevention of infection and control (ASPIC). Indian J Med Res 2014;139:226-30.
8. Khan A. Patterns of prescription of antimicrobial agents in the department of otorhinolaryngology in a tertiary care teaching hospital. Afr J Pharm Pharmacol 2011;5:1732-8.
9. Mathai E, Chandy S, Thomas K, Antoniswamy B, Joseph I, Mathai M, et al. Antimicrobial resistance surveillance among commensal Escherichia coli in rural and urban areas in Southern India. Trop Med Int Health 2008;13:41-5.
10. Jain D, Sinha S, Prasad KN, Pandey CM. Campylobacter species and drug resistance in a north Indian rural community. Trans R Soc Trop Med Hyg 2005;99:207-14.
11. Dellit TH, Owens RC, McGowan JE Jr., Gerding DN, Weinstein RA, Burke JP, et al. Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-77.
12. Cairns KA, Jenney AW, Abbott IJ, Skinner MJ, Doyle JS, Dooley M, et al. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust 2013;198:262-6.
13. Kanish R, Gupta K, Juneja S, Bains HS, Kaushal S. Prescribing pattern of antibiotics in the department of pediatrics in a tertiary care medical college hospital in Northern India. Asian J Med Sci 2014;5:69-72.
14. Satravanan R, Muthukumar A. A surveillance study of antibiotic use in Pondicherry. Int J Basic Clin Pharmacol 2012;1:202-10.
15. Borde JP, Kaier K, Steib-Bauert M, Vach W, Geibel-Zehender A, Busch H, et al. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center. BMC Infect Dis 2014;14:201.
16. Petri WA. Penicillins, cephalosporins and other ? lactam antibiotics. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. United States: McGraw Hill; 2011. p. 1477-504.
17. List of Recommended Antimicrobial Restrictions. QUAH Antimicrobial Stewardship Toolkit. Clinical Excellence Commission; 2013. http:// www.cec.health.nsw.gov.au/programs/quah. [Last accessed on 2019 Oct 04].
18. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.
19. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: A systematic review. J Antimicrob Chemother 2011;66:1223-30.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.