Antibiotic Utilization in Pediatric Hospitalized Patients â€“ A Single Center Study

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in paediatrics. In most cases, antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards.AIM: The main objective of this study was to analyse the consumption of antibiotics in hospitalised paediatric patients.MATERIAL AND METHODS: This retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical/DDD index) in Pulmonology, Gastroenterology and Nephrology Departments at Pediatric Clinic of the tertiary hospital. The data on the consumption of antimicrobials were collected for five years by using properly designed form. The consumption was related to days of hospital care.RESULTS: The most utilised antibiotics group in all three departments Pulmonology, Gastroenterology and Nephrology Departments were penicillins. Cephalosporins were mostly used in Pulmonology department. Metronidazole and Chloramphenicol were used in minimal quantities in all three departments.CONCLUSION: This study demonstrates that surveillance programs on antibiotic resistance should be established and accompanied by analyses of drug utilisation data which can aid in the creation of valid cross-national studies on antibiotic usage and resistance, to motivate improvements in prescribing and guideline-directed antibiotic prescribing.

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A Prospective Drug Utilisation Study and Pharmacoeconomic Analysis in Paediatric Dentistry at a Tertiary Hospital

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v19i2.27735 ◽

2020 ◽

Vol 19 (2) ◽

pp. 60-64

Author(s):

Binaya Shrestha ◽

Megha Pradhan

Keyword(s):

Drug Utilisation ◽

Pharmacoeconomic Analysis ◽

Drug Prescription ◽

Tertiary Care ◽

Tertiary Hospital ◽

Drug Expenditure ◽

Paediatric Dentistry ◽

Expensive Drug ◽

Cross Sectional ◽

Utilisation Data

Introduction: Paediatric dentistry is the branch of dentistry dealing with children from birth to adolescence. Children tend to suffer from various dental conditions which can be primarily infective in nature and hence requires drugs that can be expensive. Drug utilisation data are needed for developing and monitoring policies because data on drug expenditure are not sufficient. Methods: This was a prospective cross-sectional study conducted in the Department of Pedodontics (paediatric dentistry) of a tertiary care teaching institute in Kathmandu, Nepal from July 2019 to December 2019. During the study period a total of 200 prescriptions were collected. Analysis was conducted using MS excel 2016 and further required analysis was done using Statistical Package for the Social Sciences v22.0. Results: A total of 200 prescriptions were analysed during the study period, of which 126 were males whereas 74 were females. The most common drug prescribed was paracetamol whereas amoxicillin was the most commonly prescribed antibiotics. Most common condition was periapical abscess but space infection was the most expensive condition.There was no statistically significance between the cost of drugs prescribed for the male and female patients. Conclusions: The drug prescription pattern was found to be rational. Every institution must have their own Drugs and Therapeutics Committee as has been suggested by WHO, so that patients will be benefited through decreasing economical burden, and adverse drug reactions and that by this, therapeutic effect will be increased.

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Informing the development of a standardised approach to measure antibiotic use in secondary care: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-026792 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026792

Author(s):

Selina Patel ◽

Arnoupe Jhass ◽

Susan Hopkins ◽

Laura Shallcross

Keyword(s):

Secondary Care ◽

Scale Up ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Primary Data ◽

Antibiotic Prescribing ◽

Cochrane Central Register ◽

Antibiotic Consumption Surveillance

IntroductionEcological and individual-level evidence indicates that there is an association between level of antibiotic exposure and the emergence and spread of antibiotic resistance. The Global Point Prevalence Survey in 2015 estimated that 34.4% of hospital inpatients globally received at least one antimicrobial. Antimicrobial stewardship to optimise antibiotic use in secondary care can reduce the high risk of patients acquiring and transmitting drug-resistant infections in this setting. However, differences in the availability of data on antibiotic use in this context make it difficult to develop a consensus of how to comparably monitor antibiotic prescribing patterns across secondary care. This review will aim to document and critically evaluate methods and measures to monitor antibiotic use in secondary care.Methods and analysisWe will search Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and websites of key organisations for published reports where an attempt to measure antibiotic usage among adult inpatients in high-income hospital settings has been made. Two independent reviewers will screen the studies for eligibility, extract data and assess the study quality using the Newcastle-Ottawa scale. A description of the methods and measures used in antibiotic consumption surveillance will be presented. An adaptation of the Affordability, Practicability, Effectiveness, Acceptability, Side-effects Equity framework will be used to consider the practicality of implementing different approaches to measuring antibiotic usage in secondary care settings. A descriptive comparison of definitions and estimates of (in)appropriate antibiotic usage will also be carried out.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. The results will be published in relevant peer-reviewed journals and presented at relevant conferences or meetings where possible. This review will inform future approaches to scale up antibiotic consumption surveillance strategies to attempt to maximise impact through standardisation.PROSPERO registration numberCRD42018103375

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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 ◽

10.1371/journal.pone.0245902 ◽

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.

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Retrospective analysis of prescriptions in the management of lepra reactions: Results of a single center study from tertiary hospital in Maharashtra

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i5.17346 ◽

2017 ◽

Vol 10 (5) ◽

pp. 191

Author(s):

Madhuri Kulkarni ◽

Anant Patil ◽

Siddharth Aathawale

Keyword(s):

Retrospective Study ◽

Antimicrobial Agent ◽

Retrospective Analysis ◽

Tertiary Hospital ◽

Single Center ◽

Single Center Study ◽

Multibacillary Leprosy ◽

Center Study

Objective: To examine pattern of lepra reaction andmedicines used in the treatment of lepra reactions in a tertiary hospital. Material methods: In this retrospective study, prescriptions of patients treated for the lepra reactions were reviewed to find out prevalence of type 1 and type 2 reactions and medicines used in the treatment of lepra reactions. Results:A total of66 patients (male 59.1%; female 40.9%) with mean age of 36.6 (+13.1) years were included in the study. Multibacillary leprosy was present in 93.7% patients. A total of 39 (60%) patients had type 2 reaction whereas 26 (40%) had type 1 reaction. Mean number of medicines per patients was 7.5. Prednisolone was used in 62 (93.9%) patients with mean duration of 33.32 (+33.2) days whereas chloroquine was used in 52 (78.8%) patients for 36.6 (+27.9) days. Thalidomide was used in 25 (37.9%) patients. Analgesic and anti-inflammatory and anti-acidity drugs were used in 63 (95.4%) patients each whereas paracetamol was given to 41 (62.1%) patients. Antihistamine, antimicrobial agent and vitamins were given to 27 (40.9%), 27 (40.9%) and 35 (53.0%) patients respectively. Conclusion:Lepra 2 reaction is more common than lepra 1 reaction. Prednisolone and chloroquine are the two most commonly used medicines in the treatment of lepra reaction. Similarly, thalidomide, older drug has emerged as common treatment for lepra reaction.

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Ethical aspects in the management of antibacterial agents utilization

Italian Journal of Medicine ◽

10.4081/itjm.2010.137 ◽

2013 ◽

pp. 137-144

Author(s):

Renato Malta ◽

Salvatore Di Rosa ◽

Natale D’Alessandro

Keyword(s):

Health Care ◽

Antibacterial Agents ◽

Wide Spectrum ◽

University Hospital ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

National Guidelines ◽

Beneficial Effects ◽

Defined Daily Doses ◽

Bed Days

Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin + clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have beneficial effects on health-care costs.

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Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department

Journal of Pharmacy Practice ◽

10.1177/0897190020953032 ◽

2020 ◽

pp. 089719002095303

Author(s):

Jessica Yu ◽

Gillian Wang ◽

Ann Davidson ◽

Ivy Chow ◽

Ada Chiu

Keyword(s):

Emergency Department ◽

Community Hospital ◽

Community Acquired Pneumonia ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Local Health Authority ◽

Antibiotic Prescribing ◽

Local Health ◽

Moderate Severity ◽

Stewardship Program

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital’s emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.

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