TRENDS IN ANTIMICROBIAL PRESCRIBING: A RETROSPECTIVE ANALYSIS IN A TERTIARY CARE TEACHING HOSPITAL
DOI:
https://doi.org/10.22159/ajpcr.2026v19i1.57181Keywords:
Anti-microbial agent (AMA),, Antimicrobial Stewardship Program (ASP),, Anti-microbial Resistance (AMR)Abstract
Objectives: The objective of this study was to assess trends in antimicrobial prescribing pattern in a tertiary care teaching hospital as a foundational step toward establishing an effective antimicrobial stewardship program.
Methods: A retrospective observational study was conducted at a tertiary care hospital involving patients admitted to the medicine ward and intensive care unit (ICU) from October to December 2019. Inclusion criteria comprised patients who received at least one antimicrobial agent (AMA). Data were collected from hospital records using a validated data collection tool that had been previously piloted for accuracy.
Results: We screened 1066 patients, including 324 (30.4%) patients for whom the rationality of the selection of AMAs was assessed. Only 53.3% of prescriptions were rational, per the hospital antimicrobial policy. Of the total prescriptions, 61.2% of AMAs were prescribed empirically, 31.5% definitively, and 7.3% prophylactically. The range of antibiotics prescribed per patient was 1–4. Although crucial, culture sensitivity testing was performed for 43.3% of ICU patients and 37.9% of medicine ward patients, resulting in an overall testing rate of 38.9% among patients.
Conclusion: The implementation of ASP is crucial in combating drug resistance; however, before its implementation, an audit, as conducted here, is essential to identify areas for improvement in antimicrobial prescribing practices. Our findings highlight the need to prioritize culture and sensitivity testing and to ensure adherence to the hospital’s antimicrobial policy through continued education and training for prescribers.
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References
1. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta: US Department of Health and Human Services, CDC; 2019. Available from: https://www.cdc.gov/antibiotic-use/core-elements/ hospital.html
2. Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, et al. Access to effective antimicrobials: A worldwide challenge. Lancet. 2016;387(10014):168-75. doi: 10.1016/S0140- 6736(15)00474-2, PMID 26603918
3. Vanitha M, Vineela M, Kumar PB, Sandeep P. Prescribing pattern of antibiotics in patients attending ENT OPD in a tertiary care hospital. ISOR J Dent Med Sci. 2017;16(9):30-3.
4. Chambers HF. General principles of antimicrobial therapy. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gillman’s: The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw- Hill Press; 2006. p. 1095-110.
5. Adiveni T, Chandra DS, Sundresh NJ, Kumar BA, Padmini P, Haritha K. Analysing the rationality of antibiotics in comparing the different departments in Rmmch. J Biomed Pharm Res. 2013;2(3):74-6.
6. Alanis AJ. Resistance to antibiotics: Are we in the post-antibiotic era? Arch Med Res. 2005;36(6):697-705. doi: 10.1016/j. arcmed.2005.06.009, PMID 16216651
7. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011 Sep;134(3):281-94. PMID 21985810
8. World Health Organization, Ministry of Health and Family Welfare. National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017- 2021. Switzerland: World Health Organization; 2017. p. 1-57.
9. Ahmad A, Patel I. Schedule H1: Is it a solution to curve antimicrobial misuse in India? Ann Med Health Sci Res. 2013 Nov;3:55-6.
10. DiazGranados CA. Prospective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes. Am J Infect Control. 2012 Aug;40(6):526-9. doi: 10.1016/j.ajic.2011.07.011, PMID 21937145
11. Lee CF, Cowling BJ, Feng S, Aso H, Wu P, Fukuda K, et al. Impact of antibiotic stewardship programmes in Asia: A systematic review and meta-analysis. J Antimicrob Chemother. 2018;73(4):844-51. doi: 10.1093/jac/dkx492, PMID 29340609
12. Singh S, Menon VP, Mohamed ZU, Kumar VA, Nampoothiri V, Sudhir S, et al. Implementation and impact of an antimicrobial stewardship program at a tertiary Care Center in South India. Open Forum Infect Dis. 2019 Apr;6(4):ofy290. doi: 10.1093/ofid/ofy290, PMID 31024967
13. 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(2):71-6. doi: 10.4103/2045- 080X.112987.
14. Tolpadi A, Purandare B, Shah J, Iyer S, editors. Antibiotic Policy. 3rd ed. Pune, India: Bharati Hospital and Research Centre; 2017. p. 1-52.
15. Littmann J, Viens AM. The ethical significance of antimicrobial resistance. Public Health Ethics. 2015 Nov 1;8(3):209-24. doi: 10.1093/ phe/phv025, PMID 26566395
16. Rajopadhye BD, Palkar SH, Pandit VA, Dhande PP, Kumar M, Lalwani SK. Antimicrobial prescribing pattern in a tertiary care teaching hospital: A pilot study. Int J Basic Clin Pharmacol. 2020;9(3):465-9. doi: 10.18203/2319-2003.ijbcp20200723
17. Rajalingam B, Susan Alex A, Godwin A, Cherian C, Cyriac C. Assessment of rational use of antibiotics in a private tertiary care teaching hospital. Indian J Pharm Pract. 2016;9(1):14-8. doi: 10.5530/ ijopp.9.1.4
18. Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, et al. Variations in antibiotic use across India: Multi-centre study through Global Point Prevalence survey. J Hosp Infect. 2019 Nov 1;103(3):280-3. doi: 10.1016/j.jhin.2019.05.014, PMID 31170422
19. Khavane K, Addepalli V, Bhusare K, Payghan SA, Patweakar S, Kate V. Prescribing patterns of antibiotics and sensitivity patterns of microorganisms towards different antibiotics in multidisipinary health care hospital. Int J Pharm Biol Arch. 2010;1(2):115-22.
20. Rathinavelu M, Satyagama S, Reddy R, Reddy YP. Drug use evaluation of antimicrobials in healthcare resource limited settings of India. Indian J Pharm Pract. 2015;8(4):191-5.
21. Vachhani PK, Singh AP. A prospective study of the impact of microbiological cultures on antibiotic prescribing pattern in a tertiary care hospital. Int J Pharm Pharm Sci. 2021;13(3):26-9. doi: 10.22159/ ijpps.2021v13i3.40341
22. 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 Med J. 2016 Jan;31(1):35-9. doi: 10.5001/omj.2016.07, PMID 26816567
23. Kumari A, Goyal J, Chandalia S, Rustage K, Attri R, Gupta B. Evaluation of rational use of antibiotics in intensive care unit of a tertiary care hospital in north India. MedPlus Int J Pharmacol. 2019 Aug;11(2):21-4. doi: 10.26611/10101122
24. Sonawane RC, Mahajan HM. A prospective observational study on usage of antibiotics in a tertiary care hospital of Northwest Maharashtra. Int J Curr Pharm Rev Res. 2025;17(8):796-9.
25. Ayele AA, Gebresillassie BM, Erku DA, Gebreyohannes EA, Demssie DG, Mersha AG, et al. Prospective evaluation of ceftriaxone use in medical and emergency wards of Gondar university referral hospital, Ethiopia. Pharmacol Res Perspect. 2018 Feb;6(1):e00383. doi: 10.1002/prp2.383, PMID 29417764
26. 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(5):2285-89.
27. Bade D, Shivashankaramurthy KG, Kiran LJ, Raghuprasada MS, Harishkumar VS, Pradeep AN. A cross sectional study on prescription pattern of drugs in upper respiratory tract infections in a tertiary care hospital. Int J Basic Clin Pharmacol. 2020;9(2):271-5. doi: 10.18203/2319-2003.ijbcp20200175.
28. Zarb P, Goossens H. European surveillance of antimicrobial consumption (ESAC): Value of a point-prevalence survey of antimicrobial use across Europe. Drugs. 2011;71(6):745-55. doi: 10.2165/11591180- 000000000-00000, PMID 21504250
29. Karuniawati HI, Yulianti T, Aini DK, Nurwienda FI. Impact of antimicrobial stewardship program on the use of antibiotics in pneumonia patients at teaching hospital in Surakarta Indonesia. Int J Appl Pharm. 2021;13(1):20-3. doi: 10.22159/ijap.2021.v13s1.Y0067
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Copyright (c) 2025 Dr. Bhagyashri Rajopadhye, Dr.Sonali Palkar, Vasundhara Londhe
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