ABSTRACT
Background: Pediatric diarrhea is the second most common cause of childhood mortality globally. Despite being self-limiting, polypharmacy is rampant in their treatment. The adherence of practitioners to the recommended guidelines can be assessed by drug utilization studies. Aim and Objectives: The aim of the study was to assess the drug utilization pattern of acute diarrhea management in children. Materials and Methods: A prospective observational study was undertaken for 12 months at pediatric inpatient unit of BRIMS, Bidar. Prescriptions of 400 cases of acute diarrhea in children of either gender aged 1?12 years were evaluated for the pattern of drugs prescribing using the WHO core indicators. Results: The study showed male preponderance with 54.75% being males. Every prescription, on an average had five drugs for diarrheal management. About 43.5% prescriptions had at least two antibiotics. Out of a total of 2237 drugs prescribed, 1392 (62.2%) drugs were prescribed as injections. About 78.5% medicines were selected from the National List of Essential Medicines (NLEM), 2015 and 87.12% drugs were from the hospital formulary. Drugs were categorized as per ATC/DDD system using the WHO reference DDDs and ATC codes website. PDD to DDD ratio of majority of drugs was 0.99. Conclusion: We observed polypharmacy in practice for diarrheal illness in our study. Accentuation on evidence-based management and adherence to the treatment guidelines may help in improved and rational drug use in children.
ABSTRACT
Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using ?2-test and multinomial logistic regression.Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (>7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.