Evaluation of Current Practice of Antimicrobial Prescription in Patients with Bacterial Pneumonia at a Teaching Hospital: A Prospective Study
Creators
- 1. Assistant Professor, Department of Microbiology, Government Medical College and Maharashtra Postgraduate Institute of Medical Education and Research, MUHS, India
- 2. Radiologist, Military Hospital, Ambala Cantt, Ambala, India
- 3. Assistant Professor, Adesh Medical College and Hospital, Shahbad, District Kurukshetra, Near Ambala Cantt, India
- 4. JR-1, Dept of Pharmacology, Dr Vasantrao Pawar Medical College, Hospital and Research Centre, Maharashtra, India
- 5. Intern, Dr Vasantrao Pawar Medical College, Hospital and Research Centre, Maharashtra, India
- 6. Professor and Head, Department of Microbiology, Government Medical College and Maharashtra Postgraduate Institute of Medical Education and Research, MUHS, India
Description
Objectives: The primary intention of this study incorporated an analysis of the utilization pattern of antimicrobial drugs within the inpatients diagnosed with bacterial pneumonia (BP). Material and Methods: A prospective observational study was undertaken within the Department of General Medicine to examine patients diagnosed with bacterial pneumonia (BP). Detailed records of antimicrobial prescriptions were precisely noted, with subsequent computation of both the Daily Defined Dose (DDD) and Antibiotics Consumption Index (ACI) in accordance with the World Health Organization Anatomical Therapeutic Chemical (WHO ATC) classification system. Additionally, adherence to WHO-prescribed indicators for antibacterial agent utilization was assessed. Dataset containing information of 130 patients was meticulously examined, and subsequent descriptive statistical analyses were applied employing Microsoft Excel and appropriate software packages. Result: The predominant empirical therapy for antibacterial agents was found to be amoxicillin-clavulanic acid, utilized by 73 patients (56%), succeeded by levofloxacin, administered to 33 patients (25%). Following culture and sensitivity testing, the most frequently employed antibacterial agents for definitive therapy included levofloxacin for 31 patients (24.0%), ceftriaxone for 23 patients (17.7%), meropenem for 18 patients (13.8%), and azithromycin for 10 patients (7.7%) and Doxycycline for 6 patients (4.6%). Notably, the highest Antibiotics Consumption Index (ACI) value recorded was 14.2 for amoxicillin-clavulanic acid in empirical therapy, while for definitive therapy; levofloxacin exhibited an ACI of 14.6. A noticeable disparity in ACI values between empirical and definitive therapy was observed (p<0.05), suggesting statistically meaningful differences. Furthermore, a substantial proportion of patients, 115 individuals (88%), received multiple antibacterial prescriptions. The average number of drugs prescribed per patient was 7.69±2.2, with an average of 2.68±1.85 antibiotics per prescription. Approximately 34% of prescribed drugs were denoted by their generic names, indicating a notable size of generic drug usage within the study group. Conclusion: The findings of the present study highlighted a significant pattern in the utilization of antibiotics for the treatment of bacterial pneumonia (BP) within the Medicine Department. This analysis focuses on the need for the implementation of antimicrobial treatment guidelines (Antibiotic policy) within the hospital setting, aiming to enhance the efficacy and rationality of antibiotic usage while concurrently optimizing the allocation of scanty healthcare resources. Such guidelines can work as a crucial framework for clinicians, promoting standardized practices and upholding judicious antibiotic prescribing practices, ultimately contributing to improved patient outcomes and minimisation of antimicrobial resistance. It can also be concluded that tertiary care hospital requires a coordinated mediation to improve rational use of antimicrobials and therefore the clinical outcomes also by improving efficacy and reducing the cost and the chances of adverse effects through establishing an antimicrobial stewardship program and strict implementation of Hospital Antibiotic policy.
Abstract (English)
Objectives: The primary intention of this study incorporated an analysis of the utilization pattern of antimicrobial drugs within the inpatients diagnosed with bacterial pneumonia (BP). Material and Methods: A prospective observational study was undertaken within the Department of General Medicine to examine patients diagnosed with bacterial pneumonia (BP). Detailed records of antimicrobial prescriptions were precisely noted, with subsequent computation of both the Daily Defined Dose (DDD) and Antibiotics Consumption Index (ACI) in accordance with the World Health Organization Anatomical Therapeutic Chemical (WHO ATC) classification system. Additionally, adherence to WHO-prescribed indicators for antibacterial agent utilization was assessed. Dataset containing information of 130 patients was meticulously examined, and subsequent descriptive statistical analyses were applied employing Microsoft Excel and appropriate software packages. Result: The predominant empirical therapy for antibacterial agents was found to be amoxicillin-clavulanic acid, utilized by 73 patients (56%), succeeded by levofloxacin, administered to 33 patients (25%). Following culture and sensitivity testing, the most frequently employed antibacterial agents for definitive therapy included levofloxacin for 31 patients (24.0%), ceftriaxone for 23 patients (17.7%), meropenem for 18 patients (13.8%), and azithromycin for 10 patients (7.7%) and Doxycycline for 6 patients (4.6%). Notably, the highest Antibiotics Consumption Index (ACI) value recorded was 14.2 for amoxicillin-clavulanic acid in empirical therapy, while for definitive therapy; levofloxacin exhibited an ACI of 14.6. A noticeable disparity in ACI values between empirical and definitive therapy was observed (p<0.05), suggesting statistically meaningful differences. Furthermore, a substantial proportion of patients, 115 individuals (88%), received multiple antibacterial prescriptions. The average number of drugs prescribed per patient was 7.69±2.2, with an average of 2.68±1.85 antibiotics per prescription. Approximately 34% of prescribed drugs were denoted by their generic names, indicating a notable size of generic drug usage within the study group. Conclusion: The findings of the present study highlighted a significant pattern in the utilization of antibiotics for the treatment of bacterial pneumonia (BP) within the Medicine Department. This analysis focuses on the need for the implementation of antimicrobial treatment guidelines (Antibiotic policy) within the hospital setting, aiming to enhance the efficacy and rationality of antibiotic usage while concurrently optimizing the allocation of scanty healthcare resources. Such guidelines can work as a crucial framework for clinicians, promoting standardized practices and upholding judicious antibiotic prescribing practices, ultimately contributing to improved patient outcomes and minimisation of antimicrobial resistance. It can also be concluded that tertiary care hospital requires a coordinated mediation to improve rational use of antimicrobials and therefore the clinical outcomes also by improving efficacy and reducing the cost and the chances of adverse effects through establishing an antimicrobial stewardship program and strict implementation of Hospital Antibiotic policy.
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Additional details
Dates
- Accepted
-
2024-03-05
Software
References
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