Inappropriate antibiotic use for respiratory infections in outpatient settings

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir. Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data. Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names. Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.

Assessment of Antibiotic Prescription Pattern Using who Prescribing Indicators and Aware Categorization of Antibiotics

Background: Medicines play a crucial role in the healthcare delivery of a hospital. The appropriate use of medicines gives us assessment of the quality of health services being provided in a particular region. Aim: To evaluate the prescribing practices and antibiotic utilization patterns so that the extent of irrational use can be assessed by comparing them with published ideal values set by WHO. Study design: Retrospective, cross-sectional study. Place and duration of study: Teaching Hospital of Faisalabad: Independent University Hospital (IUH), from Jan 2018 to June/July 2018. Methodology: 200 cases were selected through systematic random sampling from medicine/surgery wards and pharmacy registers. The standard World Health Organization prescribing indicators and AWaRe categorization of antibiotics were used to assess the prescribing practices of physicians/surgeons. Published ideal standards for each of the indicators were compared with study findings to identify extent of irrational drug use. Results: Most of the facility indicators were met with. The Drug and Therapeutic Committee (DTC) was functional. The Standard treatment guideline booklets (STGs) and Essential Drugs List (EDL) of the hospital were available. 88% of the key drugs listed in EDL were available in stock. The expenditure on antibiotics compared to total medicines was 17%. Regarding prescribing indicators: the average number of drugs prescribed per encounter was 6 (optimal value 1.6–1.8). Average no of antibiotic per prescription amounted to almost 1 (0.925). % prescriptions with an antibiotic amounted to 72% (optimal value 20-26.8%).72% antibiotics were prescribed from the EDL formulary of the hospital (optimal value 100%). Conclusion: Regarding compliance with prescribing indicators and AWaRe categorization of antibiotics by WHO, significant deviation was observed. Education and training of physicians according to WHO parameters is required to ensure rational prescribing. Keywords: Prescription pattern, WHO Prescribing Indicators, AWaRe Categorization

Drug utilization study on pediatric pneumonia patients in a tertiary care teaching hospital

Background: Pneumonia remains the prime infectious disease that increases the mortality rate among children under five claimed the lives of nearly 1.5 million children in 2015. Mortality due to childhood pneumonia is linked to the prevalence and relapse increases and usage of antibiotics is more. In such circumstances, the main. Aim: The Aim of the study was to assess the utilization of drugs and to spot the factors that contribute to the pediatric pneumonia patients at tertiary care teaching hospitals. Material and methods: A prospective, observational study was conducted from May 2021 to October 2021Overall 310 prescriptions were collected, 204 patients were included in the study based on inclusion criteria and data was collected from a proforma and by using WHO prescribing indicators study is analyzed. Results: Age group with pneumonia of<5years was 171 patients, followed by 33 patients between 6-8years.The male children constituted the major portion i.e. 120(58.82%) followed by female children were 84(41.18%). Distribution of drugs per prescription, majority of prescriptions with<5 drugs i.e., 110(56%) followed by 82 prescriptions with 5-10 drugs constituted (43%), this indicates the polypharmacy and 1 prescription with >10 drugs i.e., (1%). The distribution of antibiotics where majorly preferred drug in penicillin’s were amoxiclav- 164(59.20%), least preferred was piperacillin/tazobactam-9(3.28%), followed by cefotaxime-38(13.71%), ceftriaxone -17(6.13%), amikacin- 31(11.19%), and azithromycin- 18(6.49%). Conclusion: In our study, we observed an irrational use of antibiotics and polypharmacy of drugs in the treatment of pediatric pneumonia.

Pola Peresepan Anak dengan Infeksi Saluran Pernapasan Akut (ISPA) Non Pneumonia di Klinik

Acute respiratory infection (ARI) is a common disease in the community. Riskesdas 2018 stated that ARI prevalence was 4.4% and the highest was in 1-4 years old children (8%). The capitation payment system in clinics collaborated with BPJS Kesehatan demands the physician to prescribe as effective and as efficient as possible. On the other hand, the capitation tariff obtained by clinics is considered as too low, thus constrains of the prescription leading to irrational prescribing is likely to occur. This study analyses further the prescribing pattern for ARI children in clinics and its rationality based on the difference in source of funding. A cross sectional research using retrospective method was conducted. Data were gathered from 409 medical records and or patients’ prescription of children between 1-12 years old and diagnosed as having non pneumonia ARI during 1st January to 30th November 2019. Result showed that non pneumonia ARI patients were mostly boys (54,3%) aged 1-5 years old (6.0%). The average number of items for BPJS patients was 3,45, the percentage of generic prescribing was twofold higher for BPJS group (63.94%), the percentage of essential medicine prescribing was 63.96% while the percentage of antibiotic use was lower (48.50%). Dosage propriety for BPJS patients was 70.80% which was slightly higher than non-BPJS group. Overall, the prescribing indicators and dosage properness for BPJS patients were better than non-BPJS patients.

EVALUATION OF DRUG-PRESCRIBING PATTERNS AT OUTPATIENT CLINICS OF PUBLIC HEALTH FACILITIES IN MIRPUR AZAD KASHMIR

Objective: To evaluate prescribing practices in public health facilities of district Mirpur, Kashmir where no previous evidence regarding drug-prescribing behaviours was available. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Methodology: The prescribing pattern analysis was done by objective observations of prescriptions after patient-physician encounter. World health organization defined core and complementary prescribing indicators were evaluated for all the prescriptions. Results: Among the core prescribing indicator, average number of medicines per prescription were 3.11 (World Health Organization’s standard, 1.6-1.8). Only 2% and 67% of medicines were generic and essential medicines respectively (standard, 100%). Almost half the prescriptions contained antibiotics (standard, 20-26.8%) whereas 8% had injections (standard, 13.4- 24.1%). Among the complementary indicators there was no prescription without medicines and average prescription cost was 479 Pakistani Rupees. Conclusion: This is the first study to give a snapshot of prescribing behaviours in public health facilities in Kashmir. All the prescribing indicators except injectables were below the standards. A multi-disciplinary approach involving authorities, industry and professionals is required to promote rational prescribing.

Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)

BackgroundMost patients with mental illness are managed in primary care, yet there is a lack of data exploring potential prescribing safety issues in this setting for this population.ObjectivesExamine the prevalence of, between-practice variation in, and patient and practice-level risk factors for, 18 mental health-related potentially hazardous prescribing indicators and four inadequate medication monitoring indicators in UK primary care.MethodCross-sectional analyses of routinely collected electronic health records from 361 practices contributing to Clinical Practice Research Datalink GOLD database. The proportion of patients ‘at risk’ (based on an existing diagnosis, medication, age and/or sex) triggering each indicator and composite indicator was calculated. To examine between-practice variation, intraclass correlation coefficient (ICC) and median OR (MOR) were estimated using two-level logistic regression models. The relationship between patient and practice characteristics and risk of triggering composites including 16 of the 18 prescribing indicators and four monitoring indicators were assessed using multilevel logistic regression.Results9.4% of patients ‘at risk’ (151 469 of 1 611 129) triggered at least one potentially hazardous prescribing indicator; between practices this ranged from 3.2% to 24.1% (ICC 0.03, MOR 1.22). For inadequate monitoring, 90.2% of patients ‘at risk’ (38 671 of 42 879) triggered at least one indicator; between practices this ranged from 33.3% to 100% (ICC 0.26, MOR 2.86). Patients aged 35–44, females and those receiving more than 10 repeat prescriptions were at greatest risk of triggering a prescribing indicator. Patients aged less than 25, females and those with one or no repeat prescription were at greatest risk of triggering a monitoring indicator.ConclusionPotentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm.

Assessment of prescription completeness and antibiotic consumption at a rural health and training centre, Delhi

Background: The prescription audit is a useful method to assess the doctors’ contribution to the rational use of drugs in a country. A prescription is considered complete when it covers all the parts of the prescription. The polypharmacy increased the risk of drug interaction, dispensing errors and confused the patients for dosage schedules. A prescription with the minimum number of drugs per prescription helps in rational pharmacotherapeutics. The objectives of this study were to describe the pattern and completeness of prescription at rural health and training center and to estimate antibiotic consumption at rural health and training center.Methods: A descriptive cross-sectional study was conducted to determine the current prescribing practice at RHTC. Data were collected in the two pharmacies of the rural hospital. A total of 612 prescriptions with the last refill were considered for the assessment.Results: The average number of drugs prescribed per prescription 3.53. The percentage of prescriptions in which an antibiotic was prescribed was 20%. The percentage of drugs prescribed by generic name and from an essential drug list was 71.5% and 98.7% respectively. The most commonly prescribed form of antibiotics was extended-spectrum penicillin.Conclusions: All the prescriptions were complete covered parts of prescriptions. The dosing errors were present in maximum prescriptions. The WHO prescribing indicators were within the limits, an average number of drugs per prescription suggests a practice of polypharmacy. The peak of the use of antibiotics was observed in September followed by January and November. The least use of antibiotics was in December followed by June.

Investigation and Comparison of Medicine Use in the three Central Referral Hospitals in Sierra Leone

Background: An important goal of National Medicines Policy is to ensure that sufficient quantities of essential medicines are available to health care providers and affordable to patients.Objectives: To investigate and compare the prescribing indicators, patient care indicators and facility indicators in three central referral Hospitals in Sierra Leone.Methods: This was a simple randomized retrospective and prospective study. Three groups were obtained to assess prescribing, patient care and facility indicators in the study sites. About 10% of the prescriptions encountered from January to June 2019, were observed retrospectively. Direct observation of 30 randomly selected patients in each hospital was used to assess patient care. Data collected were organized using Microsoft Excel and analyzed using SPSS version 21. Ethical considerations were observed.Results: The average number of medicines prescribed in the three teaching hospitals (Connaught, PCMH and ODCH) were 4.07, 4.3and 3.3 respectively. Percentage encounter with injections were within standard in PCMT and ODCH. Antibiotics prescribing was slightly higher that WHO recommendation of 30% in all 3 hospitals. Percentage of medicines prescribed by generics were 75.4%, 53% and 77% respectively. The average consultation time was 5.47 minutes while the average dispensing time was 79.7 seconds. Patients that receive their medications at Connaught Hospitals had very little knowledge on how they should take their medicine(s), compared to PCMH and ODCH.Conclusion: This study has shown that irrational use of medicines is a major problem in the three referral hospitals occurring majorly during the prescribing and dispensing processes.

Drug Utilisation Pattern in Ear, Nose and Throat Inpatient Department using WHO Prescribing Indicators

Introduction: Assessment of drug utilisation pattern (DUP) based on World Health Organisation (WHO) drug prescribing indicators would enhance the standards of patient care at all levels of the healthcare. It helps to improve the quality of life in developing countries like Nepal. Objective: To assess DUP in patients admitted in ear, nose and throat inpatient department at a tertiary hospital in Eastern Nepal using the WHO prescribing indicators. Methods: A hospital based cross-sectional descriptive study was carried out in 96 patients in ENT department of a tertiary care teaching hospital from February-April 2019. Pre-designed proforma was used to collect the relevant data from the medical case sheets and drug charts. Descriptive statistics were calculated using Microsoft Excel 2010. Results: Out of 96 patients, 52 (54.17%) were female. Most of the patients (46, 47.18%) were pre­scribed four drugs. Combination of Ibuprofen and Paracetamol (77, 19.74%) was the commonest prescribed drug. Ceftriaxone (62, 63.92%) was the most frequently prescribed systemic antibiotic. The average number of drugs per prescription was 4.06. None of the drugs were prescribed by generic name. Out of 360 drugs, only 118 (30.26%) were prescribed from National List of Essential Medicines (NLEM) and 117 (30.00%) drugs were fixed drug combinations. Ninety two (95.83%) patients had been prescribed at least one antibiotic. Conclusions: The prescribing practices of essential medicines, generic drugs, antibiotics and inject­able drugs showed deviation from the standard recommended by the WHO. The prescribers should be motivated to enhance prescription of drugs by generic names and from NLEM.