TRENDS IN ANTIMICROBIAL PRESCRIBING: A RETROSPECTIVE ANALYSIS IN A TERTIARY CARE TEACHING HOSPITAL
Keywords:
Anti-microbial agent (AMA),, Antimicrobial Stewardship Program (ASP),, Anti-microbial Resistance (AMR)Abstract
Background:
Antimicrobial agents (AMA) are crucial for treating infections, but their misuse significantly contributes to the rise of antimicrobial resistance (AMR). Implementing an Antimicrobial Stewardship Program (ASP) is essential to optimize AMA use and mitigate AMR. This study aimed to understand antimicrobial prescribing patterns at a tertiary care teaching hospital as a foundational step towards establishing an effective ASP.
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 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, the culture sensitivity test was done only for 43.338.9% of 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.
Keywords: Anti-microbial agent (AMA), Antimicrobial Stewardship Program (ASP), Anti-microbial Resistance (AMR)
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References
1. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. Available at https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
2. Laxminarayan R, Matsoso P, Pant S, Brower C, Rottingen JA, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016;387:168e75
3. Vanitha M and Vineela M: Prescribing pattern of antibiotics in patients attending ENT OPD in a tertiary care hospital. ISOR-JDMS 2017; 16(9): 30-33
4. Chambers HF. General Principles of antimicrobial therapy. In BruntonLL, Lazo JS,ParkerLI Goodman and Gillman's The Pharmacological basis of therapeutics 11th ed. New York:Mc Graw-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. Journal of Biomedical and Pharmaceutical Research. 2013;2(3):74-6.
6. Alanis AJ. Resistance to antibiotics: Are we in the post-antibiotic era? Arch Med Res 2005; 36:697–705.
7. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, et al ; Global Antibiotic Resistance Partnership (GARP) - India Working Group. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011 Sep;134(3):281-94.
8. World Health Organization, Ministry of Health and Family Welfare. National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017–2021. 2017; 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;55–6.
10. Diaz Granados 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.
11. Lee CF, Cowling BJ, Feng S, et al. Impact of antibiotic stewardship programmes in Asia: a systematic review and meta-analysis. J Antimicrob Chemother 2018; 73:844–51.
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)
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;4:71-6.
14. 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 JBasic Clin Pharmacol 2020;9:465-9
15. Rajalingam B, Alex AS, Godwin A, Cherian C, Cyriac C. Assessment of rational use of antibiotics in a private tertiary care teaching hospital. Indian Journal of Pharmacy Practice. 2016;9(1)
16. Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, Sharma A, Sahu S, Nirkhiwale S, Gupta S, Rohit A. Variations in antibiotic use across India: a multicentre study through Global Point Prevalence survey. Journal of Hospital Infection. 2019 Nov 1;103 (3):280-3.
17. 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 multidisciplinary health care hospital. International Journal of Pharmaceutical and Biologic Archives. 2010;1(2): 115-22
18. Rathinavelu M, Satyagama S, Reddy R, Reddy YP. Drug use evaluation of antimicrobials in healthcare resource-limited settings of India. Indian Journal of Pharmacy Practice. 2015;8(4).
19. 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 medical journal. 2016 Jan;31(1):35
20. Kumari A, Goyal J, Chandalia S, Rustage K, Attri R, Goyal B. Evaluation of rational use of antibiotics in intensive care unit of a tertiary care hospital in north India. Med Int J Pharmacology. 2019 Aug;11(2):21-4
21.Ahmad A, Parimalakrishnan S, Guru PM, Patel I and Manna PK: A Study on utilization pattern of higher generation antibiotics among patients visiting community pharmacies in Chidambaram. Int J Pharm 2012; 2(3): 466- 71.
22. Jokandan SS, Jha DK. A study of prescribing pattern of antibiotic in a tertiary care hospital – an observational study. Int J Pharm Sci Res 2019;10(5):2285-8918
23. 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;9:271-5
24. Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point-prevalence survey of antimicrobial use across Europe. Drugs 2011;71:745e55
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