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Background: Antimicrobial resistance is defined as the ability of microorganism (bacteria, fungus, virus, or parasite) to resist the effects of a drug to inhibit microorganism growth, which is becoming a major concern worldwide particularly in developing country like India. Aim and Objectives: The aim of this study was to identify, compare, and assess the appropriateness of antimicrobials prescribed in a rural tertiary care hospital and those prescribed by rural private practitioners and to assess the average cost of antimicrobials per prescription. Materials and Methods: A cross-sectional study was conducted, in which a total of 2003 prescriptions were analyzed from outpatient department (OPD) of rural tertiary and prescriptions from nearby chemist shops for prescription pattern, cost, and appropriateness. Results: It was identified that most of the antimicrobial containing prescriptions in both private and public health sector were prescribed by MBBS doctors (56.33%). In Government Medical College (GMC) OPDs, antimicrobials were prescribed mostly for gastrointestinal infection (25.75%) and beta lactams (45.23%) followed by fluoroquinolones (27.10%) were the most commonly prescribed. While among rural private practitioners, gastrointestinal infections (33.50%) followed by fever (27.70%) were the most common clinical conditions, for which antimicrobials were prescribed and 13.40% prescriptions contained more than one antimicrobial. About 43.37% of antimicrobials prescribed in OPDs of GMC and 56.20% antimicrobials prescribed by private practitioners were found to be inappropriate which was statistically significant. Conclusion: The study concluded that around half of the prescriptions analyzed were inappropriate and so there is a strict need of supervising the antimicrobials prescribing patterns, consumption, and it’s dispensing from the pharmacy shops.
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Background: Infectious disease represent a major cause of mortality and morbidity in India. Pattern of use of antibiotics need to be studied separately as they vary from adult, however there is limited data is available, Therefore the aim of our study is to observe the drug utilization and antimicrobial prescription pattern and drug utilization in department of pediatrics at our tertiary care hospital.Methods: This was a prospective observational study carried out among indoor patients admitted to paediatric ward after obtaining approval by Institutional Ethics Committee. Written informed consent obtained from a parent or legal guardian of participants.Results: 100 patients were enrolled. The maximum number of antibiotics were prescribed from cephalosporin class (75; 43.6%) out of which ceftriaxone (42;56%), Cefixime (20;26.6%), cefotaxim (11;14.6%), cefpodoxime (3;4%), cefazolin (1;1.33%). The majority of cephalosporins were prescribed in Gastrointestinal tract infections (60.66%) followed by respiratory (27.2%) and least in cvs (2.66%), secondly higher group of antimicrobial prescribed was from Aminopenicillin class accounting of (36; 21.9%) which includes amoxiclav (35;97.2%), ampicillin (1;2.7%) and other beta lactamase (3;1.7%) consisting meropenem (2;66.7%), piperacillin with tazobatcam (1;33.3%). The majority of aminopenicillin were prescribed in respiratory tracts infections and very less in other systems. Miscellaneous drugs used in respiratory conditions were bronchodilator, systemic steroid and nasal decongestant; in CNS disorders antiepileptic and diuretics; in cardiovascular disease NSAID, inotropic, antihypertensive, diuretics; in genitourinary tract infections alkalizing agent and steroid and in GIT disorders minerals, rehydration fluids, antispasmodic probiotic were used.Conclusions: We conclude that commonly prescribed drugs were from 3rd generation cephalosporins followed from extended spectrum penicillin with ? lactmase inhibitor. Majority of the antimicrobials are used empirically.
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Se realizó un estudio descriptivo y transversal de 32 niños, tratados con antimicrobianos, quienes se encontraban ingresados en el Hospital Infantil Norte Docente "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba, desde julio hasta diciembre del 2013, con vistas a identificar los cambios en la prescripción de estos antimicrobianos. Se halló que la mayoría de estas prescripciones se realizaron en los pacientes de 4-5 años de edad que presentaron infecciones respiratorias, y el agente causal mayormente aislado fue el neumococo. Entre los antibacterianos que fueron cambiados primaron: penicilinas, cefalosporinas y macrólidos, los cuales se sustituyeron debido a la inadecuada evolución de los afectados, así como a los resultados del antibiograma. Otras variables, tales como edad, localización de la infección, así como tipo y duración del tratamiento no influyeron en la decisión del cambio.
A descriptive and cross-sectional study of 32 children, treated with antimicrobials who were admitted in "Dr. Juan de la Cruz Martínez Maceira" Northern Teaching Children Hospital in Santiago de Cuba, was carried out from July to December, 2013, aimed at identifying the changes in the prescription of these antimicrobials. It was found that most of these prescriptions were carried out in the 4-5 years patients that presented breathing infections, and the most isolated causal agent was the pneumococcus. Among the antibacterial drugs that were changed prevailed: penicillins, cephalosporins and macrolids, which were substituted due to the inadequate clinical course of those affected, as well as to the results of the antibiogram. Other variables, such as age, localization of the infection, as well as type and duration of the treatment didn't influence in the decision of the change.
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Prescription Drugs , Anti-Infective Agents , Pediatrics , Secondary Care , ChildABSTRACT
Context: Antimicrobial use has been associated with increasing antimicrobial resistance. There is an urgent need for judicious use of antimicrobials. Informational feedback has been shown to result in changes in behavioural practices of physicians in certain healthcare settings. We conducted this study to see if the passive informational feedback can reduce in antimicrobial usage in a tertiary care centre. Aims: The study was undertaken to evaluate if the feedback to clinicians on their own antibiotic prescription results in any change in their antibiotic prescription habits. Settings and Design: The study was conducted at a tertiary care setting involving 33 units of different specialties. These units were split into 10 groups based on specialty and were allocated randomly to the control (16 units) and intervention (17 units) arms of the study. This study was a prospective intervention to assess the effect of prescribing feedback on clinical prescribing practices. Materials and Methods: In the intervention arm, information on resistance rates and antibiotic‑prescribing patterns was provided to all doctors. Behavioural change was assessed by comparing baseline prescribing rates of each unit with prescribing rates after the intervention. In the control arm, only information on monthly resistance rates was provided. Statistical Analysis: Change in the antimicrobial prescribing rates in the treatment group was assessed by using a Student’s t‑test. Results: The mean antibiotic use for all the specialties was 189 DDDs/100BDs. The prospective intervention did not elicit any effect on the antibiotic prescribing practices of the physicians. Low prescribers continued to prescribe antibiotics at a low rate, and high prescribers continued to prescribe at a high rate. Conclusions: In view of unfavourable results of passive intervention in the above study, active intervention may be more effective.
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OBJETIVO: caracterizar la prescripción de antimicrobianos en pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica descompensada. MÉTODOS: estudio descriptivo, de corte transversal, que incluyó a 131 pacientes con enfermedad pulmonar obstructiva crónica descompensada, a quienes se les prescribió algún antimicrobiano en salas de medicina interna del Hospital Clinicoquirúrgico Joaquín Albarrán, La Habana, Cuba, entre mayo del 2011 y abril del 2012. Se identificaron las principales causas de exacerbación, se describió la prescripción de antimicrobianos y se determinó su relación con la severidad de la descompensación y con la estadía hospitalaria. Se analizaron los resultados obtenidos a través de programa estadístico SPSS. RESULTADOS: el 65 por ciento de los pacientes presentaron una descompensación infecciosa. La prescripción de antimicrobianos se realizó de forma empírica en el 92 por ciento de los casos, e inadecuada en el 49 por ciento de ellos. Se demostró la existencia de una relación estadísticamente significativa entre la severidad de la descompensación y la prescripción de antimicrobianos. CONCLUSIONES: se prescribió antimicrobianos de manera inadecuada en cinco de cada diez pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica descompensada, mayormente en aquellos casos sin haberse constatado diagnóstico positivo de infección respiratoria. A medida que disminuye la severidad de la descompensación, incrementa la incidencia de prescripción inadecuada(AU)
OBJECTIVE: to characterize the prescription of antimicrobials in patients with decompensated chronic obstructive pulmonary disease. METHODS: descriptive and cross-sectional study that covered 131 patients with chronic obstructive pulmonary disease, who were prescribed some kind of antimicrobials in the internal medicine wards of Joaquin Albarran clinical and surgical hospital located in Havana, Cuba in the period of May 2011 through April 2012. The main causes of exacerbation were identified, the antimicrobial prescription was described and the association of severe decompensation and length of stay at hospital was determined. The statistical SPSS software analyzed the results. RESULTS: sixty five percent of patients presented with infectious decompensation. Antimicrobial prescription was mostly empirical in 92 percent of cases and inadequate in 49 percent. It was proven that the association of decompensation severity and antimicrobial prescription was statistically significant. CONCLUSIONS: antimicrobials were inadequately prescribed in five out of ten patients diagnosed with decompensated chronic obstructive pulmonary disease, mostly in those cases without proven positive diagnosis of respiratory infection. As the decompensation severity decreases, the incidence of inadequate prescription increases(AU)