Publication:

A prospective study on the pattern of antibiotic use in a tertiary care hospital

Background Indiscriminate use of antimicrobials is rampant throughout India, and this is a matter of serious concern. There are several reports linking antibiotic usage to bacterial resistance. Towards addressing this problem, community wise surveillance needs to be undertaken to monitor antibiotic exposure including their misuse. This study was meant to assess the extent and pattern of antibiotic use in a tertiary care facility.

Methods Subjects for study were patients attending a suburban hospital in central Kerala. Case records of patients who were prescribed systemic antibiotics were perused for relevant data. Seriously ill patients were excluded from the study.

Results 610 encounters with antibiotics could be identified from a total of around 2000 patient records, indicating an encounter rate of 29%; which is quite acceptable as per the WHO standard of prescribing indicators. However, more than 70% of prescriptions carried only brand names of medications. Use of antibiotics was mostly on the basis of clinical symptoms (presumptive), and culture reports were not given due credence. Prescriptions were invariably therapeutic in nature, and the concepts of surgical prophylaxis conveniently given a go by. The most common infections were those of the Upper Respiratory Tract (URTI), followed by skin and soft tissue infections. Ampicillin, azithromycin and cefuroxime were the most frequently prescribed agents. More than one third of infections were treated with a combination of antimicrobials. A general temptation for using cephalosporin - betalactamase inhibitor combinations could be related to the aggressive promotional policies of the pharmaceutical industry.

Conclusions The overall antibiotic encounter rate is acceptable as per WHO standards. But the tendency for using injections as well as antibiotic combinations is very high. Prophylactic use of antibiotics in surgical procedures is not being followed at all. A serious attempt needs to be made to implement National Guidelines for use of antimicrobials.