ABSTRACT
Background: Use of antibiotics in special population like children is not same as adult. Pediatric age group will have difference in pharmacokinetics, pharmacodynamics, efficacy, and safety of drugs. In children, the maturity of major organs will be in developing stage which would affect the absorption, metabolism, distribution, and excretion of drugs. Hence, irrational prescription of drugs may lead to many adverse effects ranging from mild to severe. In developing countries like India, we do not have much unbiased information on the currently used drugs. Hence, the current study focused on antibiotic use among pediatric population using data from a tertiary care teaching hospital. Aim and Objectives: The objectives of the study were as follows: (i) To observe antibiotic prescription trends in in-patients of pediatric ward and (ii) to analyze rationality of antibiotic prescription. Materials and Methods: It is a prospective observational study which was conducted over a period of 1 year. Institutional Ethics Committee approval was taken before conducting the study. The data of inpatients of pediatric ward were collected in a separate well-designed preform. Inpatients with age group of 0–14 years were included in the study. Results: Out of 1050 patients, 471 were below the age group of 1 year, 220 patients were between 1 and 5 years, and 359 patients were above the age of 5 years. The percentage of patients with antibiotic prescribed was 92.1%. Respiratory tract infections were predominantly seen among children, especially bronchopneumonia was seen in 6.6% of the patients. Among the antibiotics, amikacin (483) was most commonly prescribed followed by cefotaxime (414) and ceftriaxone (301). Conclusion: In our study, we have found that antimicrobials were most commonly used drugs in the form of injectable. To prevent development of antimicrobial resistance, there is necessary of antibiotic policy in each and every hospitals of India.
ABSTRACT
Background: Diabetes increases the risk of infection and the commonest amongst them are the ones involving the genitourinary tract. Diabetic patients are found to have an increase in the risk of developing urinary tract infection (UTI) by 60%. The study aimed to determine the causative pathogens and their antimicrobial pattern, identify risk factors associated in type 2 diabetic subjects having UTI. Methods: This was an observational study conducted in the medicine unit of a tertiary care hospital over a period of 8 months. A total of 619 (M:F 289:330) type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1C%). Diagnosis of UTI was made from midstream urine samples of patients if the urine cultures has >103 to >105 colony forming units (CFUs)/mL of a pathogen. Results: Among the 619 diabetic patients 220 patients had pus cells in urine but 72 patients had insignificant colony count. 90 (60.8%) patients were more than 60 years old, 48 (32.4%) were in the age group of 40-60 years and 10 (6.7%) were less than 40 years old. Among the 148 patients studied 52 (35.1%) were males and 96 (64.9%) were females. 116 (78.4%) had diabetes for more than 15 years and the rest had a duration lesser than 15 years. The HbA1C of patients with and without UTI were 10.2 ± 1.6 and 8.4 ± 1.3 respectively. Gram negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram negative bacilli including E. coli, the Klebsiella species, pseudomonas and Citrobacter had good response to piperacillin-tazobactum, cefoperazone sulbactum, imipenam and amikacin. Gram positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively). Conclusions: Female gender, age and duration of diabetes were found to have increased risk factors for developing UTI in diabetes. Escherichia coli was the commonest organism causing UTI in diabetes which showed good response to piperacillin/tazobactum, cefoperazone-sulbactum, imipenam and amikacin.