Evaluating antimicrobial prescribing in a Tertiary Healthcare Institution in Nigeria

Abstract Background Regular evaluation of antimicrobials prescriptions is important for optimal use. Objective This study determined the prescription patterns, class and costs of antimicrobials in the adult out-patient pharmacy of a Teaching Hospital in Nigeria. Methods A 1-year retrospective study from 1st January to 31st December 2018. The data, which included identification code, age, sex, antibiotics prescribed, number of antibiotics per prescription, number of medicines per prescription, dosage form, generic prescribing, drug on the essential drug list, and cost, were used in the analysis. The Chi-square test and Analysis of Variance were used to compare our data with the WHO–developed antimicrobial prescription Guidelines for Anatomical Therapeutic Chemical and Defined Daily Dose assignment of 2019. Results From 450 patient records, significantly more females (70%) were prescribed with antimicrobials (P = 0.0038). The prescription pattern showed that antimicrobials selection by class was significantly different (P < 0.0001) (top three being Amino-penicillin > Nitroimidazoles > Fluoroquinolone). In addition, age differed significantly (P < 0.0001) with 46–50 as the highest class. Dosage forms profile showed that the percentage of encounter with injections prescribed (1.8%) was less than WHO recommendation (13.4–24.1%). Most of the prescriptions (84.22%) were from the Essential Drug List. The average cost of prescriptions with two antimicrobials was the highest ($14.0807), then three ($10.7949), and one ($6.39858). The average number of drugs per prescription that had one (4.28), two (4.46), and three (5.55) antimicrobials, respectively, were more than double the average (2) recommended by WHO. Conclusion The study showed that most of the patterns are within limit, however, highlights the need for frequent evaluation.

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Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180646 ◽

2018 ◽

Vol 7 (3) ◽

pp. 363 ◽

Cited By ~ 1

Author(s):

Ajitha Sharma ◽

Shweta Oommen

Keyword(s):

Standard Treatment ◽

Treatment Guidelines ◽

Defined Daily Dose ◽

Adherence To Treatment ◽

Essential Drug ◽

Essential Drug List ◽

Drug List ◽

Daily Dose ◽

Standard Treatment Guidelines ◽

Physician Adherence

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 χ2-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.

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Assessment of drug utilization among geriatric patients based on defined daily dose concept in a rural tertiary care teaching hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20204092 ◽

2020 ◽

Vol 9 (10) ◽

pp. 1538

Author(s):

K. Padmavathi ◽

S. A. Arun Raaj ◽

S. Subash ◽

C. K. Dhanapal ◽

S. Periasamy

Keyword(s):

Drug Utilization ◽

Geriatric Patients ◽

Anatomical Therapeutic Chemical ◽

Tertiary Care ◽

Defined Daily Dose ◽

College Hospital ◽

Care Teaching ◽

Essential Drug List ◽

Daily Dose ◽

Collection Form

Background: The objectives of the study were to use the anatomical therapeutic chemical classification (ATC) /defined daily dose (DDD) concept to study the drug utilization pattern in geriatric patients in a rural tertiary care teaching hospital.Methods: An observational study was conducted at Rajah Muthiah Medical College Hospital (OPD and IPD) over a period of six months from November 2018 to April 2019. The data was collected from 204 patients using specially designed data collection form. The patients were selected based on inclusion and exclusion criteria. Results: A total of 204 patients were included in this study. The study population consisting of males 130 (63.7%) and females 74 (36.2%). Diseases related to the cardiovascular system 67 (32.84%) were the most common cause for the geriatric patients to attend the hospital, followed by surgical diseases 47 (23.03%), Oncological diseases 2 (0.98%) were the least frequency encountered. The average number of drugs prescribed per prescription was 8.79. Out of 1795 drugs prescribed, 60.86% of drugs were prescribed in generic form, and 39.14% were prescribed in brand name. The study analysed that 71.25% of drugs prescribed were from essential drug list (EDL) 2016-2018. Number of prescriptions with an injection was 74.04%. Paracetamol (N02B01) was the most frequently prescribed drug, followed by Amlodipine (C08CA01), Dexamethasone (H02AB02), Clopidogrel (B01AC04), Ferrous sulfate (B03AA07), Acetylsalicylic acid (B01AC06), Hydrocortisone (H02AB09), Tamsulosin (G04CA02), Atorvastatin (C10AA05), Furosemide (C03CA01).Conclusions: Drug utilization study can help in evaluating the quality of care given to the geriatric patients and promote rational use of medicines.

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Recent study on safety monitoring herbal medicines of Thai National Essential Drug List (NEDL)

Planta Medica ◽

10.1055/s-0029-1234680 ◽

2009 ◽

Vol 75 (09) ◽

Author(s):

Y Oppamayun ◽

W Rungapirumnan ◽

W Suwanakaesawong ◽

C Uerchaikul

Keyword(s):

Herbal Medicines ◽

Safety Monitoring ◽

Essential Drug ◽

Essential Drug List ◽

Drug List

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WHO-essential drug list (WHO-EDL)

Dictionary of Pharmaceutical Medicine ◽

10.1007/978-3-211-89836-9_1472 ◽

2009 ◽

pp. 193-194 ◽

Cited By ~ 1

Keyword(s):

Essential Drug ◽

Essential Drug List ◽

Drug List

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Evaluation of rational drug use pattern using WHO prescribing indicators in a medical intensive care unit of a tertiary teaching hospital in Kerala, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20172111 ◽

2017 ◽

Vol 6 (6) ◽

pp. 1328

Author(s):

Shobha P. ◽

Messaline Sunitha

Keyword(s):

Tertiary Care ◽

Care Hospital ◽

Prescribing Practices ◽

Essential Drug ◽

Prescribing Pattern ◽

Respiratory Problems ◽

Essential Drug List ◽

Drug List ◽

Tertiary Teaching ◽

Set Up

Background: ICU patients are exposed to more number of life saving drugs and face drug related problems like therapeutic failure, drug interactions and frequent adverse drug reactions. The cost of ICU hospitalisation and money spent on medicines is also a huge burden on these patients. A study of prescribing pattern in an ICU set up will serve as a medical audit to monitor and evaluate the prescribing practices to make it more rational and cost effective.Methods: A prospective observational study was carried out in a medical ICU of a tertiary care hospital. All the inpatients admitted in the medical ICU during the study period of 2 months were included in the study. The data obtained from the case sheets were used to assess the prescribing pattern and rationality of drug use.Results: A total of 101 patients were admitted in 2 months. The most common illness for which the patients (22) were admitted was respiratory problems. Average number of drugs per prescription was 6.9. Cardiovascular system (23.9%) drugs were the most frequently prescribed. Pantoprazole (77) was the single most commonly prescribed drug. 40% of the drugs were prescribed from the essential drug list. The average cost of medicines incurred per person in our study was 5126.33 in INR.Conclusions: Polypharmacy and unwanted prescription of proton pump inhibitors can be avoided by prescribing more generics and drugs from essential drug list.

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DRUG PRESCRIPTION PROFILE AND PERINATAL DETERMINANTS DURING THE FIRST YEAR OF LIFE

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.39 ◽

2015 ◽

Vol 101 (1) ◽

pp. e1.33-e1

Author(s):

Daniele Piovani ◽

Antonio Clavenna ◽

Chiara Pavoni ◽

Maurizio Bonati

Keyword(s):

Anatomical Therapeutic Chemical ◽

Drug Prescription ◽

Drug Prescriptions ◽

First Year ◽

Chi Square ◽

Lombardy Region ◽

Drug Classes ◽

Chi Square Test ◽

Socio Demographic Factors ◽

First Year Of Life

The aim of the study was to investigate the drug prescription profile during the first year of life in a cohort of newborns, and the influence of perinatal and socio-demographic factors on drug prescription.A total of 61,479 neonates born in 2011 were included. The data source was the database of reimbursed prescriptions of the Lombardy region, Italy. Drug prescriptions were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Drug prevalence was calculated as the percentage of neonates receiving at least one drug prescription in one year. Chi-square test was used to compare prevalence of drug prescription in males and females.In all, 42,204 infants (68.7%) received at least one drug prescription, with a prevalence slightly higher in males than females (71.1% versus 66.1%; χ2=178 p<0.01). The drug classes most commonly prescribed in the first year of life were antibiotics (39.5% of infants), anti-asthmatics (32.6%), and corticosteroids for systemic use (9.8%).The median age of first prescription was 20.6 (Interquartile range: 9.4–33.3) weeks. Males received the first prescription about one week before females (20.1 versus 21.3, respectively). The first prescription concerned mainly anti-asthmatics (40.5%), and antibiotics (37.9%), and amoxicillin (16.3%), beclomethasone (16.0%), and amoxicillin+clavulanic acid (15.0%) were the most prescribed drugs.In conclusion, in the first year of life, 7 out of 10 infants received drug prescriptions. Males were more exposed than females, a finding consistent with the epidemiology of diseases in infancy. The analysis concerning the influence of maternal and perinatal factors is ongoing.

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Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India

Indian Journal of Clinical Medicine ◽

10.1177/1177393617703343 ◽

2017 ◽

Vol 8 ◽

pp. 117739361770334 ◽

Cited By ~ 1

Author(s):

Sandeep Lahiry ◽

Avijit Kundu ◽

Ayan Mukherjee ◽

Shouvik Choudhury ◽

Rajasree Sinha

Keyword(s):

World Health Organization ◽

Drug Utilization ◽

West Bengal ◽

Anatomical Therapeutic Chemical ◽

World Health ◽

Defined Daily Dose ◽

Prescription Data ◽

Daily Dose ◽

Health Organization

Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class ( P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.

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Role of follow-on drugs and indications on the WHO Essential Drug List

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/j.1365-2710.2006.00777.x ◽

2006 ◽

Vol 31 (6) ◽

pp. 585-592 ◽

Cited By ~ 12

Author(s):

J. Cohen ◽

L. Cabanilla ◽

J. Sosnov

Keyword(s):

Essential Drug ◽

Essential Drug List ◽

Drug List

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Evaluasi Penggunaan Antibiotik Pada Pasien Anak Rawat Inap di RSD Dr. Soebandi Jember

Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) ◽

10.22487/j24428744..v.i.14976 ◽

2020 ◽

Author(s):

Sinta Rachmawati ◽

Dewi Khurmi Masito ◽

Ema Rachmawati

Keyword(s):

Antibiotic Resistance ◽

Quantitative Evaluation ◽

Pediatric Patients ◽

Anatomical Therapeutic Chemical ◽

Antibiotic Use ◽

Defined Daily Dose ◽

Resistance Risk ◽

Condition Evaluation ◽

Daily Dose ◽

Active Substances

Infection is one of the health problems. It is mostly caused by bacteria. The increased incidence of bacterial infection results in higher antibiotic use. It can lead to antibiotic resistance risk. Antibiotic resistance may occur in pediatric patients. Morbidity, mortality, and high cost of medication are impact of this condition. Evaluation of antibiotic use needs to be done to ensure responsible use of antibiotics. ATCD/DDD (Anatomical Therapeutic Chemical/ Defined Daily Dose) method can be used to evaluate antibiotic use quantitatively. ATC classification is a system of grouping active substances according to their location of action and DDD is a measurement system that is connected to the ATC code.The purpose of this study was determining the profile of antibiotic use and measuring quantitative evaluation with ATC/DDD method in pediatric patients. The data was collected by observing the hospital medical record. The results of this study showed that cephalosporin (46,22%) was the most used group and cefotaxime (31,15%) was the most used type of antibiotic. While, the quantitative evaluation with ATC/DDD method indicated that the highest of antibiotic use was ceftriaxone (11,30 DDD/100 patient days) and the lowest was amikacin (0,03 DDD/100 patient days)

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Assessment of veterinary drugs dispensing practices in veterinary clinics in Gondar town, North West Ethiopia: a cross sectional study

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20212835 ◽

2021 ◽

Vol 7 (8) ◽

pp. 395

Author(s):

Birhanu Berihun Kidanu ◽

Dak Chuol Cay ◽

Zemene Demelash Kifle

Keyword(s):

Treatment Guideline ◽

Continuous Medical Education ◽

Veterinary Drug ◽

Essential Drug ◽

Cross Sectional ◽

Veterinary Clinic ◽

Essential Drug List ◽

Drug List ◽

Dispensing Practices ◽

Gondar Town

Background: Dispensing practice plays a major role in the provision of rational drug therapy. This study aimed to assess the veterinary drug dispensing practice by pharmacists and other veterinarian assistance in veterinary clinic Gondar town.Methods: A cross-sectional prospective descriptive study was carried out in the OPD of three public veterinary clinics in Gondar town for three months. The health facility indicators were examined by ensuring the good dispensing practices in three veterinary clinic and availability of essential drug list.Results: The average consultation time was 13 min and 50 sec. The average dispensing time was 5 min and 3 sec calculated from 100 prescriptions. The percentage of drugs dispensed was 97.50% and percentage of drugs adequately labeled was high from the dispensed drugs (74.4%). The average patients with drug dosage knowledge were very low (25%). The result of the study revealed that the two veterinary clinic health facilities do not have any essential drug list. Out of three, one of them has a key drug from the WHO list 1 (30%) drug was available.Conclusions: The overall good dispensing practices at three veterinary clinics is low. Training, supportive supervision through continuous medical education, regular up-to-date medicine information and standard treatment guideline, and therapeutic audit are required for improvement of medicine use by prescriber and dispensers.

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