Pattern of inappropriate antibiotic use among patients in the medical wards of a tertiary hospital in southwest Nigeria

Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.

Rational prescribing practice assessment among resident doctors in a tertiary care teaching hospital: a questionnaire based observational study

Background: One of the important factors in health policy is recognised to be rational use of medicines (RUM). Physicians can influence the health and well-being of patients by prescribing appropriate drug in right doses and they should be taught to prescribe rationally at the earliest of their professional carrier.Methods: This cross-sectional, questionnaire-based study was carried out in SMHS hospital which is a tertiary-care teaching hospital associated with Government Medical College, Srinagar, Jammu and Kashmir, India.Results: Out of 106 resident doctors enrolled in the study, 96.2% respondents were aware about the term essential medicines of India, and 47.6% had National List of Essential Medicines of India available at their work place. When the participants were questioned about the term RUM only 17% of them responded positively, but majority of the resident doctors (88.67%) were aware about the ingredients of the drugs they use to prescribe. Though only 3.7% of our participating doctors always use essential medicines during their prescription writing but majority of them (96.22%) would always use to inform the patient regarding disease, drug therapy and monitoring of drug therapy.Conclusions: Considering the fact that respondents are future prescribers they should be aware of all aspects about RUM and improper knowledge in certain areas of RUM is a matter of concern that needs to be addressed.

A KAP study of pharmacovigilance among junior residents and interns of a tertiary care hospital

Background: Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems. An “adverse drug reaction” is any noxious, unintended and undesired effect of a drug, which occurs at a dose used in humans for prophylaxis, diagnosis, therapy or modification of physiological functions. Reporting of adverse events and adverse drug reactions is the commonest method utilized for generating safety data. Lack of awareness about Pharmacovigilance is one of the most important causes of such under-reporting. Spontaneous reporting system is considered the main mechanism of pharmacovigilance study for gathering information about ADRs. Hence this study was undertaken to assess the knowledge, attitude and practice regarding Pharmacovigilance among junior residents and interns in a tertiary care hospital.Methods: A cross-sectional study was carried out in 134 doctors using pre-validated 20 item questionnaire with details of participant’s information followed by questions regarding knowledge, attitude and prescribing practice of pharmacovigilance was used as a tool, administrated to all the resident doctors and the collected data was analysed.Results: Our study revealed that knowledge about pharmacovigilance was not adequate to JRs and INTs. Survey results revealed that the knowledge of pharmacovigilance among doctors 63 (88.73%) JR and 49 (77.78%) INTs had a knowledge score of less than 50%. This shows that only few doctors are aware about the pharmacovigilance programme. The assessment of questionnaire based on attitude regarding pharmacovigilance shows that 21 (29.58%) JR and 17 (26.98%) of INTs had attitude score of 70% and above. The attitude score was less compared to the knowledge score of JRs and INTs. 52 JR and 58 INTs stated that they have not been trained on how to report ADRs and basic orientation about pharmacovigilance which hinders the process of practicing pharmacovigilance. Conclusions: For the success of Pharmacovigilance programmes only knowledge and attitude regarding Pharmacovigilance is not enough as is evident from our study. Success of Pharmacovigilance programmes depend also upon the effective practice of Pharmacovigilance by healthcare professionals.

Prescribing pattern of cough and cold medicines in central Gujarat.

Background: Cough and common cold are one of the commonest morbidities in the community. Cough and cold medicines are abound in Indian market despite the fact that majority of them lack scientific evidence of their use in this common condition. Aims & Objective: To analyze the prescribing pattern of ‘cough and cold’ medicines in Central Gujarat. Material and Methods: An observational, cross-sectional, questionnaire- based study was carried out to assess the prescribing pattern of doctors with regard to cough and cold. A total of 100 prescribers with a graduate degree (n=50) or a post-graduate degree (n=50) from Central Gujarat were selected randomly. After interviewing all doctors, data were analyzed to find the percentage of patients prescribed ‘cough & cold medicines’, their types of dosage form, use of FDCs, indications, any adverse events encountered and non-pharmacological measures advocated. Results: Prescribing FDCs for cough and cold was significantly higher (92% vs 72%, P<0.05) in post graduate prescribers attached to private hospitals than in graduate prescribers attached to government/teaching hospitals. Usage of solid dosage forms was significantly higher (p<0.05) in prescribers attached to government or teaching hospitals as compared to prescribers attached to private hospitals (84% vs 60%). About 18% of graduate and 25% of post graduate prescribers gave cough and cold medicines at patients’ behest. Only 15% prescribers prescribed cough and cold medicines for dry cough while antihistamines were advocated by 96% of prescribers. About 50% of the physicians prescribed these medicines for conditions like upper and lower respiratory tract infections. Non pharmacological measures were recommended by 75% prescribers. Conclusion: Efforts are needed to create awareness amongst prescribers about the rational use of cough & cold medicines and also pay attention to ADR caused by them. Reforms in medical education and CME are recommended.

A survey of physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies / Un estudio sobre los conocimientos y actitudes de los médicos en relación con la resistencia antimicrobiana y la práctica de prescripción de antibióticos en el Hospital Universitario de West Indies

OBJECTIVE: To identify physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies (UHWI). METHODS: A cross-sectional survey of physicians at the UHWI was conducted between September 2008 and April 2009 using a 28-item, self-administered questionnaire. Eligible physicians from several specialities were identified from departmental rotas. RESULTS: A total of 174 physicians completed the questionnaire, a response rate of 73%. Most physicians considered antibiotic resistance to be an extremely important global problem (55%) but less significant nationally (35%). Factors identified as important in producing resistance included wide-spread use of antibiotics (91%), inappropriate empiric choices (79%) and use of broad-spectrum agents (70%). Hand-washing was not considered to be important in reducing resistance. Useful interventions included access to current information on local resistance patterns (90%), institutional specific antibiotic guidelines (89%) and educational programmes (89%). Antibiotic cycling (40%) and restriction (35%) were regarded as less helpful. Knowledge of resistance-prone antibiotics and specific resistant organisms at the UHWI was poor, except for methicillin-resistant Staphylococcus aureus (MRSA). Empiric therapy for common infections was appropriate in most cases, and antibiotic choices were guided by availability of drugs (89%) and patient factors such as renal disease or allergy (80%). Only 45% of physicians would de-escalate to a narrow-spectrum antibiotic guided by a microbiology report, and consultants were more likely to de-escalate therapy than junior staff (p = 0.002). CONCLUSIONS: Although physicians were aware of the problem of resistance to antibiotics and the contributory factors, their practice did not reflect measures to reduce it. Continuing educational programmes and institution-specific antibiotic prescribing guidelines are needed.

OBJETIVO: Identificar los conocimientos y actitudes de los médicos con respecto a la resistencia antimicrobiana y la práctica de prescripción de antibióticos en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se llevó a cabo un estudio transversal en UHWI, entre septiembre del 2008 y abril del 2009 de abril, usando un cuestionario autoadministrado de 28 puntos. Los médicos elegibles de varias especialidades fueron identificados de las listas departamentales. RESULTADOS: Un total de 174 médicos completaron el cuestionario, para una tasa de respuesta del 73%. La mayor parte de los médicos consideró que la resistencia antibiótica constituye un problema sumamente importante desde un punto de vista global (55%) pero menos significativo desde una perspectiva nacional (35%). Los factores identificados como importantes en la formación de la resistencia incluyeron el uso generalizado de antibióticos (91%), las elecciones empíricas inapropiadas (79%), y el uso de agentes de amplio espectro (70%). El lavarse las manos no se consideró importante para la reducción de la resistencia. Las intervenciones útiles incluyeron el acceso a la información corriente sobre patrones de resistencia locales (90%), normas institucionales específicas sobre el uso de antibióticos (89%) y programas educativos (89%). El ciclo (40%) y la restricción (35%) de los antibióticos se consideraron menos útiles. El conocimiento de antibióticos con tendencia a la resistencia y organismos resistentes específicos en el HUWI era pobre, excepto en el caso del Staphylococcus aureus resistente a la meticilina (SARM). La terapia empírica para las infecciones comunes fue apropiada en la mayoría de los casos, y las opciones antibióticas estuvieron dictadas por la disponibilidad de medicamentos (89%) y factores relacionados con los pacientes, tales como enfermedades renales o alergias (80%). Sólo el 45% de los médicos desescalarían a un antibiótico de estrecho espectro guiado por un informe microbiológico, y los consultantes mostraron una tendencia mayor a desescalar la terapia, en comparación con la observada en el personal subalterno (p = 0.002). CONCLUSIONES: Aunque los médicos tenían conciencia del problema de la resistencia a los antibióticos y los factores contribuyentes, su práctica no reflejó las medidas para reducirla. Se necesitan programas de educación continua y normas institucionales específicas para la prescripción de antibióticos.