scholarly journals Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study

2019 ◽  
Vol 16 (21) ◽  
pp. 4074
Author(s):  
Elisabeth Silfwerbrand ◽  
Sumeer Verma ◽  
Cora Sjökvist ◽  
Cecilia Stålsby Lundborg ◽  
Megha Sharma
Keyword(s):  
Private Sector ◽  
Treatment Guidelines ◽  
Inappropriate Prescribing ◽  
Central India ◽  
Prescribing Patterns ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Suppurative Otitis Media ◽  
Common Diagnosis

Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient departments of two private-sector Indian hospitals. Data of all consecutive inpatients (n = 3527) were collected but analyzed for the inpatients aged >15 years (n = 2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses groups: surgical, non-surgical, chronic suppurative otitis media (CSOM), and others. Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% of patients in the clean surgery group and more than 75% in the viral and non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis (31%), where 90% of inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. This study highlights the inappropriate prescribing of antibiotics to patients of clean surgeries, viral infections, and non-infectious groups. The single-prophylactic dose of antibiotic for clean-contaminated surgeries was replaced by the prolonged empirical prescribing. The use of microbiology investigations was insignificant.

scholarly journals Diagnose-Specific Antibiotic Prescribing Patterns at the Otorhinolaryngology Inpatient Departments of Two Private Healthcare Facilities in Central India: A Five Year Observational Study

2019 ◽  
Author(s):  
Elisabeth Silfwerbrand ◽  
Sumeer Verma ◽  
Cora Sjökvist ◽  
Cecilia Stålsby Lundborg ◽  
Megha Sharma
Keyword(s):  
Teaching Hospital ◽  
Prescribing Patterns ◽  
World Health ◽  
Healthcare Sector ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Suppurative Otitis Media ◽  
Private Healthcare ◽  
Surgery Group ◽  
Common Diagnosis

Abstract Background Antibiotics are overprescribed in low-and-middle-income countries where the infection rate is high. The global paucity of standard treatment guidelines and reliable prescription data is a barrier to rationalise antibiotic use and combat antibiotic resistance. Moreover, there is a lack of diagnose-specific prescription data from high infection risk departments such as the otorhinolaryngology (ENT). The purpose of the study was to present diagnose-specific antibiotic prescribing patterns at ENT inpatient departments of a teaching hospital and a non-teaching hospital from Indian private healthcare sector. Methods Data of all consecutive inpatients at the department (n=3527) were collected for five years (2008-2013). Analyses were conducted for inpatients aged >15 years (n=2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses (indication) groups, i.e., surgical, non-surgical, chronic suppurative otitis media (CSOM) and others. Results Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% inpatients in the clean surgery group, 78% in viral infection and 75% in non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis at both settings (883/2909 inpatients), where nearly 90% inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. Conclusions This study highlights prescribing antibiotic to the unindicated diagnosis groups, i.e., clean surgeries, viral infections, and non-infectious diagnoses. Recommended single-prophylactic dose of antibiotic was not prescribed for the majority of clean-contaminated surgeries. Prolonged empirical prescribing and insignificant use of the microbiology laboratory was evident in both settings. A meticulous analysis of clean surgery group highlighted the universal applicability issue of available global guidelines.

scholarly journals Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245902
Author(s):  
Kristina Skender ◽  
Vivek Singh ◽  
Cecilia Stalsby-Lundborg ◽  
Megha Sharma
Keyword(s):  
Design Patterns ◽  
Central India ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Essential Medicines ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Defined Daily Doses

Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

scholarly journals Assessment of Antibiotic Prescribing Patterns at Outpatient Pharmacy Using World Health Organization Prescribing Indicators

2019 ◽  
Vol 10 ◽  
pp. 215013271988694
Author(s):  
Dawit Kumilachew Yimenu ◽  
Abdurazak Emam ◽  
Endilik Elemineh ◽  
Wagaye Atalay
Keyword(s):  
Health Care ◽  
World Health Organization ◽  
Prescribing Patterns ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Prescribing Indicators ◽  
Rational Use ◽  
Essential Drugs ◽  
Health Organization

Background: Overuse of antibiotics is a common problem in health care, which leads to unnecessary expenditure on drugs, raised risk of adverse reactions, and the development of antimicrobial resistance. Inappropriate prescribing habits lead to ineffective and unsafe treatment, worsening of disease and increment of health care costs. The aim of this study was to assess antibiotic prescribing patterns using World Health Organization prescribing indicators at the outpatient Pharmacy Department of University of Gondar referral hospital, Gondar, Northwest Ethiopia. Methods: A retrospective cross-sectional study was conducted. One-year prescription data was collected from prescription and prescription registration books retained at the pharmacy store. World Health Organization/International Network of Rational Use of Drugs prescribing indicators were utilized to measure rational use of drugs with due focus on antibiotics prescribing patterns. The collected data was analyzed using SPSS version 20. Results and Discussion: A total of 968 drugs were prescribed from 600 patient encounters. The average number of drugs per encounter was 1.6. The percentage of encounters in which an antibiotics and injections were prescribed was 69.7% and 6.3% respectively. Amoxicillin (28.5%) followed by ciprofloxacin (12%) and metronidazole(11.1%) were the most commonly prescribed antibiotics. The percentage of drugs prescribed from essential drugs list and by generic name was 95.3% and 96%, respectively. Rate of antibiotics prescribing showed deviation from the standard recommended by World Health Organization whereas polypharmacy, injectable prescribing pattern, uses of brand names, and prescription of drugs from the National Essential Drugs List were not found to be a significant problem though there were slight deviations from the standard. Conclussion: Interventions aimed at improving the antibiotic prescribing patterns need to be implemented so as to prevent the inappropriate use of antibiotics and avoid further complications.

scholarly journals Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – A time series analysis over 10 years

2020 ◽  
Author(s):  
Anna Damlin ◽  
Megha Sharma ◽  
Gaetano Marrone ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Time Series ◽  
Antibiotic Resistance ◽  
Infectious Diseases ◽  
Private Sector ◽  
World Health ◽  
Fixed Dose ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Prescribing Practices ◽  
Choice Of Treatment

Abstract Background: Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended.Methods: Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization’s (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and t-tests were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values <0.05 were considered significant.Results: In total, 3,766 patients were included, 2,504 inpatients in the NTH and 1,262 in the TH, of which 92% and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO’s second-choice of treatment, the watch category, comprised 29% and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P <0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P <0.05). Conclusions: Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.

scholarly journals An Evaluation of Antibiotic Prescribing Practices in a Rural Refugee Settlement District in Uganda

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 172
Author(s):  
Matua Bonniface ◽  
Winnie Nambatya ◽  
Kalidi Rajab
Keyword(s):  
Treatment Guidelines ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
National Treatment ◽  
Cross Sectional

Ensuring access to effective antibiotics and rational prescribing of antibiotics are critical in reducing antibiotic resistance. In this study, we evaluated antibiotic prescribing practices in a rural district in Uganda. It was a cross-sectional study that involved a retrospective review of 500 outpatient prescriptions from five health facilities. The prescriptions were systematically sampled. World Health Organization core medicine use prescribing and facility indicators were used. Percentage of encounters with one or more antibiotics prescribed was 23% (10,402/45,160). The mean number of antibiotics per prescription was 1.3 (669/500). About 27% (133/500) of the diagnoses and 42% (155/367) of the prescriptions were noncompliant with the national treatment guidelines. Prescribing antibiotics for nonbacterial infections such as malaria 32% (50/156) and noninfectious conditions such as dysmenorrhea and lumbago 15% (23/156) and nonspecific diagnosis such as respiratory tract infection 40% (59/133) were considered noncompliant with the guidelines. On average, 68% (51/75) of the antibiotics were available on the day of the visit. Inappropriate prescribing practices included excessive use of antibiotics and failure to diagnose and prescribe in compliance with treatment guidelines. There is a need to strengthen antibiotic use in the health facilities through setting up stewardship programs and interventions to promote adherence to national treatment guidelines.

scholarly journals Prescribing patterns of cardiovascular drugs in cardiology outpatient department in a tertiary care hospital in Western Odisha

2020 ◽  
Vol 10 (1) ◽  
pp. 23
Author(s):  
Ayan Roy ◽  
Nayan Kumar Patel
Keyword(s):  
Drug Utilization ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cardiovascular Drugs ◽  
Prescribing Patterns ◽  
World Health ◽  
Fixed Dose ◽  
Care Hospital ◽  
Clinical Practices ◽  
Common Diagnosis

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified.

scholarly journals Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India

PLoS ONE ◽  
2015 ◽  
Vol 10 (11) ◽  
pp. e0142317 ◽  
Author(s):  
Megha Sharma ◽  
Anna Damlin ◽  
Ashish Pathak ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Private Sector ◽  
Central India ◽  
Antibiotic Prescribing

scholarly journals 1139. Multidisciplinary Initiative to Increase Guideline-Concordant Antibiotic Prescriptions at Discharge for Hospitalized Children with Uncomplicated Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S405-S406
Author(s):  
Alexandra B Yonts ◽  
Michael Jason Bozzella ◽  
Matthew Magyar ◽  
Laura O’Neill ◽  
Nada Harik
Keyword(s):  
Infectious Diseases ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Community Acquired Pneumonia ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Median Percentage ◽  
Common Diagnosis ◽  
The Impact

Abstract Background Community-acquired pneumonia (CAP) is the most common diagnosis in hospitalized children. The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America published evidenced-based clinical practice guidelines for the management of CAP in children 3 months of age or older in 2011. These guidelines are not consistently followed. Our objective was to evaluate if quality improvement (QI) methods could improve guideline-concordant antibiotic prescribing, specifically addressing the use of oral third-generation cephalosporins, at hospital discharge for children with uncomplicated CAP. Methods QI interventions, implemented at a single tertiary care children’s hospital in Washington, D.C., focused on key drivers targeting hospital medicine resident teams. Multiple plan-do-study-act (PDSA) cycles were performed. Initial interventions included educational sessions (in small group and lecture formats) aimed at pediatric resident physicians, as well as visual job aids (Figure 1) and guideline summaries posted in resident physician work areas. Interventions were implemented in series to allow for statistical analysis via run chart. Medical records of eligible patients were reviewed monthly after each intervention to determine the impact on appropriate discharge antibiotic prescribing. Results At baseline, the median percentage of children with a diagnosis of uncomplicated CAP discharged with guideline-concordant antibiotics was 50%. Median rates of guideline-concordant antibiotic prescribing improved to 87.5% after initial interventions (Figure 2). Conclusion A fellow-led multidisciplinary QI initiative was successful in decreasing rates of non-guideline-concordant antibiotic prescribing at discharge. These interventions can be tailored for use at other institutions and for other infectious processes with established treatment guidelines. To ensure sustained improvement in guideline-concordant prescribing, future planned interventions include additional educational sessions with residents, faculty, and pharmacists, EMR order set modification and physician benchmarking. These tactics are intended to address the anticipated challenge of resident/faculty turnover and automate antibiotic choice for uncomplicated CAP. Disclosures All authors: No reported disclosures.

scholarly journals Drug utilization patterns of antidepressants in Federal Neuro-Psychiatric Hospital Lagos, Nigeria

2017 ◽  
Vol 6 (5) ◽  
pp. 12 ◽  
Author(s):  
Oyinlade A. Kehinde ◽  
Emmanuel N. Anyika ◽  
Isaac Abah
Keyword(s):  
Average Cost ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Prescribing Patterns ◽  
World Health ◽  
Rational Drug ◽  
Generic Prescribing ◽  
Cost Of Drugs ◽  
Health Organization

Backgroud: The paucity of information on prescribing patterns and use of antidepressants in accordance with practice guidelines necessitated this study in Nigeria.Objective: To assess the prescribing patterns of antidepressants, average cost of prescriptions and the index of rational drug prescribing (IRDP) in a Nigerian tertiary care hospital.Methods: A retrospective study which involved the assessment of 683 prescriptions and case records of patients who received antidepressants from 1st January 2013 to 31st December 2014 was conducted. Information on diagnosis, patients’ demographics, prescribing patterns and cost of medications was obtained therefrom. Compliance to the World Health Organization (WHO) prescribing indicators and Nigerian Standard Treatment Guidelines (STG) was assessed. The IRDP for antdepressants was determined using a validated mathematical model. The statistical analysis was performed using SPSS version 20.Results: Tricyclic antidepressants (TCAs) were the most commonly prescribed drug group (61.3%), followed by selective serotonin re-uptake inhibitors (SSRIs) with a total of 38.7%. On the average, three drugs were prescribed per prescription, while 60.3% and 38.3% of the drugs were prescribed from National Essential Medicine List (NEML) and STG respectively. The IRDP was 3.96 over 5 points. The average cost of drugs per prescription was 4.2 USD. The cost of drugs in the prescriptions written according to STG was lower compared to that in prescriptions not compliant with the STG (p < .001).Conclusions: TCAs are the most commonly prescribed antidepressants due to their affordability. The generic prescribing, medicines prescribed from the NEML and in compliance with the STG were less than the WHO standard. The rational drug use is suboptimal. Better prescribing habits, affordability and use of newer antidepressants should be encouraged by the hospital management.

scholarly journals Validity of World Health Organisation prescribing indicators in Namibia’s primary healthcare: findings and implications

2018 ◽  
Vol 31 (5) ◽  
pp. 338-345 ◽  
Author(s):  
Q Niaz ◽  
B Godman ◽  
A Massele ◽  
S Campbell ◽  
A Kurdi ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Treatment Guidelines ◽  
Survey Design ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Medicine Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Independent Risk Factor

Abstract Objective World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.

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