• ACHINI ABERATHNA Faculty of Medicine, University of Ruhuna, Sri Lanka
  • HANA MORRISSEY University of Wolverhampton United Kingdom
  • PATRICK BALL University of Wolverhampton United Kingdom
  • SHUKRY ZAWAHIR Faculty of Medicine, University of Ruhuna, Sri Lanka



Antibiotic cost, Sri Lanka, Antibiotic resistance, Antibiotics utilization, Emergency department


Objective: Anecdotal evidence suggested that antibiotics are frequently used in the Emergency Treatment Units in Sri Lanka, mostly for the respiratory tract, soft tissue or urinary tract infections. This study aimed to describe the utilization patterns of antibiotics in terms of most common type, indication and associated direct cost in ETU at the Teaching Hospital Karapitiya, Sri Lanka.

Methods: In this study, utilization patterns and the direct cost of antibiotics in an emergency treatment unit was evaluated by checking the bed-head tickets of all patients admitted to the unit from 1/5/16 to 15/5/16. Out of the 414 bed-head tickets checked 156 patients were receiving antibiotic treatment. Socio-demographic characteristics were analyzed. The prices of antibiotics in SriLankan government hospitals were taken from the hospital medical supply division price list. Data were analyzed by Microsoft Excel™.

Results: In this study, 45.5% (out of 156 patients) were aged between 61-80years. The most used antibiotic was amoxicillin/clavulanic acid (18.1%) and clarithromycin (15.5%). Generic antibiotics were used for most patients (95.58%). Fixed-dose combinations were used in 18.5% of cases, including amoxicillin/clavulanic acid and piperacillin/tazobactam. The common indications for prescribing antibiotics were respiratory tract infections (31.2%) and soft tissues injuries (12.1%).

Conclusion: This study revealed that there is apparent overuse of antibiotics and reveals that antibiotic stewardship programme could reduce antibiotic use, antibiotic resistance, and cost. Improved understanding of the rationale for antibiotic use would contribute optimising their use. Further studies are needed to establish the extent of sub-optimal prescribing of antibiotics in Sri Lankan hospitals.


Download data is not yet available.


1. Farlex I. Emergency department, the definition of emergency department by medical dictionary; 2015.
2. Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis. BMC Emergency Med 2011;11:16.
3. Kaur S, Rajagopalan S, Kaur N, Shafiq N, Bhalla A, Pandhi P, et al. Drug utilization study in the medical emergency unit of a tertiary care hospital in north India. Emerg Med Int 2014;973578.
4. Ojeniran M, Shouval R, Miskin IN, Moses AE, Shmueli A. Costs of appropriate and inappropriate use of antibiotics in the emergency department. Israel Med Assoc J 2010;12:742–6.
5. Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: a systematic review and meta-analysis. PLOS One 2017;12:e0189621.
6. Holloway K, Dijk LV. The world medicines situation. Rational use of medicines. WHO; 2011. Available from: [Last accessed on 05 Jul 2019].
7. Holloway KA, Kotwani A, Batmanabane G, Puri M, Tisocki K. Antibiotic use in southeast asia and policies to promote appropriate use: Reports from country situational analyses. Br Med J 2017;358:9-13.
8. Sharma S, Bowman C, Alladin Karan B, Singh N. Antibiotic prescribing patterns in the pediatric emergency department at Georgetown Public Hospital Corporation: a retrospective chart review. BMC Infectious Diseases 2016;16:170.
9. Al-Niemat SI, Bloukh DT, Al-Harasis MD, Al-Fanek AF, Salah RK. Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators. Saudi Med J 2008;29:743–8.
10. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. Br Med J 2010;340:1-11.
11. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infectious Diseases 2011;11:692-701.
12. WHO. Introduction to drug utilization research introduction to drug utilization research; 2003.
13. Zenker C, Lang P. Drug emergency patients are a burden for the medical care system: inadequate care for drug emergency patients. Forensic Sci Int 1993;62:117–20.
14. Truter I. A review of drug utilization studies and methodologies. Jordan J Pharm Sci 2008;1:91–104.
15. Gama H. Drug utilization studies. Arquivos Medicina 2008;22:69-74.
16. Al Balushi KA, Al-Shibli S, Al-Zakwani I. Drug utilization patterns in the emergency department: a retrospective study. J Basic Clin Pharm 2013;5:1–6.
17. Cheekavolu C, Pathapati RM, Laxmansingh KB, Saginela SK, Makineedi VP, Siddalingappa Kumar A. Evaluation of drug utilization patterns during initial treatment in the emergency room: a retroprospective pharmacoepidemiological study. ISRN Pharmacol 2011;1–3. 261585.
18. Donnelly JP, Baddley JW, Wang HE. Antibiotic utilization for acute respiratory tract infections in U. S. emergency departments. Antimicrobial Agents Chemother 2014;58:1451–7.
19. Tagwireyi DD, Ball DE, Nhachi CF. Routine prophylactic antibiotic use in the management of snakebite. BMC Clinical Pharmacol 2001;1:7.
20. Sumpradit N, Wongkongkathep S, Poonpolsup S, Janejai N, Paveenkittiporn W, Boonyarit P, et al. New chapter in tackling antimicrobial resistance in Thailand. Br Med J 2017;358:j3415.
21. Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA. Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Ann Emergency Med 2007;50:213–20.
22. Cyriac JM, James E. Switch over from intravenous to oral therapy: a concise overview J Pharmacol Pharmacother 2014;5:83–7.
23. Gupta M, Malhotra S, Chandra KK, Sharma N, Pandhi P. Utilization of parenteral anti-infective agents in the medical emergency unit of a tertiary care hospital: an observational study. Pharmacoepidemiol Drug Saf 2014;13:653–7.
24. Galayduyk N, Colodner R, Chazan B, Flatau E, Lavi I, Raz R. Adherence to guidelines on empiric use of antibiotics in the emergency room. Infection 2008;36:408–14.
25. Goulet H, Daneluzzi V, Dupont C, Heym B, Page B, Almeida K, et al. A prospective study of antibiotic prescribing in an emergency care unit. Med Maladies Infectieuses 2009; 39:48–54.
26. Asseray N, Bleher Y, Poirier Y, Hoff J, Boutoille D, Bretonniere C, et al. Use of antibiotics in emergency units: qualitative and quantitative assessment. Med Maladies Infectieuses 2009;39:203–8.
27. Filbin MR, Arias SA, Camargo CA, Barche A, Pallin DJ. Sepsis visits and antibiotic utilization in U. S. emergency departments. Critical Care Medicine 2014;42:528–35.



How to Cite

ABERATHNA, A., H. MORRISSEY, P. BALL, and . S. ZAWAHIR. “ANTIBIOTICS UTILIZATION PATTERNS AND DIRECT COST IN AN EMERGENCY TREATMENT UNIT IN SRI LANKA”. International Journal of Current Pharmaceutical Research, vol. 11, no. 6, Nov. 2019, pp. 119-22, doi:10.22159/ijcpr.2019v11i6.36358.



Original Article(s)

Most read articles by the same author(s)

1 2 > >>