Antimicrobial utilization pattern in a teaching district hospital of Nepal
Das, B.P.; Sethi, A.; Rauniar, G.P.
JNMA, Journal of the Nepal Medical Association 43(153): 119-124
2004
ISSN/ISBN: 0028-2715 Document Number: 260760
The objective of this study was to monitor the antimicrobial utilization in a teaching district hospital in Nepal and to compare it against the rational antimicrobial use guidelines. 106 data sheet of indoor patients admitted in year 2001 were randomly chosen and analysed. The number of antimicrobials prescribed in every prescription was taken into account to calculate the incidence of use of more than one antimicrobial agent. The patient sheet included patient information, drug information (name, indication, dose, frequency and duration of antimicrobial use), diagnosis or provisional diagnosis and investigations. Prescription auditing was done on the selected prescriptions. Male: female ratio was 40:65. In 90.57% diagnosis was established empirically and in only 4.7% patients confirmatory diagnosis was made using relevant investigations. The antimicrobials were prescribed chiefly for respiratory tract infections (RTI -26.41%), gastrointestinal infections (GIT -22.64%), genital tract infection (13.20%), wound infections (8.48%), urinary tract infections (UTI-6.6%), bone and joint infections (4.71%) and miscellaneous (typhoid, malaria, meningitis etc-17.92%). The causative organism was confirmed using culture and sensitivity tests in only one patient (0.94%) out of 106 patients. In 77 (69.8%) patient prescriptions suspected pathogenic organisms were mentioned. These were Streptococcus (29.58%), Chlamydia (11.27%), Mycoplasma (18.30%), Staphylococcus (23.94%), Escherichia coli (32.39%) and Salmonella typhi (15.49%). In 35 prescriptions (33.01) no causative organism was mentioned. It was further observed that of 452 drugs (i.e. 4.26 drugs per patient), only 165 antimicrobials (1.55 antimicrobials per patient) were prescribed in the 106 enrolled prescriptions. On further analysis of antimicrobials use, it was observed that most patients were prescribed a single antimicrobial agent (58.49%), two AMAs (24.52%), three AMAs (13.20%) and least was four AMAs (3.77%). The antimicrobials were given prophylactically in 14 (13.10%) and therapeutically in 85 (80.18%) prescriptions. The use of antimicrobials were not indicated in 7 (6.60%) prescriptions. In 91 cases (85.85%) duration for which AMAs were considered was not mentioned. Ampicillin + cloxacillin (12.12%), ciprofloxacin (10.30%), metronidazole (10.30%), amoxicillin (10.30%) and cephalosporins (25.47%) were the most frequently prescribed AMAs. A fixed dose combination of ampicillin and cloxacillin, ciprofloxacin and metronidazole were recurrently prescribed while gentamicin, cotrimoxazole and crystalline penicillin were relatively least prescribed antimicrobials agents. Inappropriate and irrationality in the antimicrobial prescribing pattern was observed.