ASSESSMENT OF ANTIBIOTIC PRESCRIBING
PATTERN OF CONSULTANTS IN DIFFERENT WARDS OF MARDAN MEDICAL COMPLEX, MARDAN
KHYBER PUKHTUNKHWA
RESEARCH
SUPERVISOR MR.HAYA HUSSAIN
DEPARTMENT
OF PHARMACY
SHAHEED
BENAZIR BHUTTO UNIVERSITY,
SHERINGAL,
DIR
(2012-2017)
CERTIFICATE
This
clinical studies project entitled “Assessment
of antibiotic prescribing behavior of consultants in different wards of Mardan
Medical Complex, Mardan Khaber Pukhtunkhwa. Prepared by Mr. Shah Haris submitted to the
Department of Pharmacy in the partial fulfillment of the requirements for the
Degree of Doctor of Pharmacy is hereby approved for submission.
Supervised by
……………………………………………………………………………………
………………………………………………………………………………………………
Mr.Haya
Hussain
Lecturer in Pharmacy
Shaheed
Benazir Bhutto University
Chairman
…….……………………………………………………………………………….
………………………………………………………………………………………………
Department of Pharmacy
Shaheed Benazir Bhutto University
External Examiner
…………………………………………………………………………………
………………………………………………………………………………………………
CONTENTS
ACKNOWLEDGEMENT………………………………………………………........i
SUMMARY....................................................................................................................ii
LIST OF TABLES……………………...…………………………………………….iv
LIST OF ABBREVIATION……...…………………………………………………..iv
CHAPTER 1: INTRODUCTION………….…………………………………………1
CHAPTER 2: LITERATURE REVIEW…………………………………………….6
CHAPTER 3: METHODOLOGY………….…………………………………………9
CHAPTER 4: RESULTS AND DISCUSSIONS……...……………………………..14
CHAPTER 5: REFERENCES…………………………...…………………………...18
“Read!
And thy Lord is Most Honorable and Most Benevolent,
Who
taught (to write) by pen, He taught man that which he knew not”
(Surah Al-Alaq 30: 3-5) Al-Quran
DEDICATION
I affectionately dedicate this effort of
mine to my beloved family, whose prayers are the secret of my success and who
are a source of strength and inspiration for me and whose blessings, guidance
and encouragement gave me confidence to achieve my goal.
ACKNOWLEDGMENT
All the praises and thanks be to Allah, The
Lord of Aallamin including all mankind, jinn and all that exists. The Most
Gracious The Most Merciful, Allah, the source of All knowledge, understanding
and wisdom, from him we owe all that we have and all that we are!. First of
all, I would like to expresses my sincerest appreciation and earnest
thankfulness to my honorable Supervisor Sir Haya Hussain, Lecturer in
department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, for his
valuable time, supervision, contribution, constant guidance, patience and wise
comments which made this study possible. I would like to pay a great thank to
my Mom, Dad and my brothers sisters. And finally I wish to thank my friends
Mohsin khan, Barkatullah, M Usman, Haleem shah, Awais Khan and my other
colleagues for their sincere cooperation and helping making this study
possible.
Shah Haris...
October,
2017
SUMMARY
A
drug used to treat bacterial infections. Antibiotics have no effect on viral
infections. Originally, an antibiotic was a substance produced by one
microorganism that selectively inhibits the growth of another. In 1926,
Alexander Fleming discovered penicillin, a substance produced by fungi that
appeared able to inhibit bacterial growth. Antibiotics are one of the most
frequently prescribed drugs in modern medicine. Antibiotics treat diseases by
killing or hurting bacteria. Most general physicians decided that antibiotics
are preventable for most of the subjects infected by microorganisms. A 60 days
clinical research study was performed in Medical A, B and C wards of Mardan
Medical Complex Mardan, KPK. Research study started from 1st
January, 2017 to March 2, 2017. The hospital serves
as a referral hospital to the patients from different parts of Mardan region
and other nearby regions such as Swabi, Malakand, Bunir and other neighborhood.
A concurrent cross-sectional hospital-based research study was conducted with
hospitalized patients. Medical record charts of patients who were admitted to
all wards during the study period were included in the study. Patients who were
taking two or more drugs concurrently for at least 48 hours were included.
During the mentioned period total 500 prescriptions were collected and were
analyzed for consultant behavior about antibiotics prescribing, male and female
ratio, frequency and percentage of the prescribed medications and age wise
percentage. Demographic history shows that male patients are more as compare to
female patients, this has been reported in so many cases, similarly age wise
prevalence was more common from age 21 to 40 years of age, male to female ratio
in our study is 1.2:1.
270
(54%) were male patients and 230 (46%) were female patients, the age between
21-40 contains total number of 245 patients out of which 140 are male and 105
are female patients, patients having ages between 81 to 100 are less
prevalence. In this piece of research study injectable are more commonly
prescribed. The number and percentage of various dosage forms are injectable
2215 (58.7%), tablets 900 (23.8%), capsules 150 (4%), suspension 100 (2.7%),
syrup 290 (7.7%) and aerosol 118 (3.1%). 500 prescriptions were evaluated in
which the total number of prescribed antibiotics are 700. Ceftriaxone is the
most prescribed antibiotic the percentage of ceftriaxone is 37.1%, the
percentages of other antibiotics are moxifloxacin 12.1%, azithromycin 8.5%,
levofloxacin and piraxicame 7.1% and clarithromycin are rarely prescribed the
percentage of which is 5.7%.
List of Abbreviations
|
COPD |
Chronic Obstructive Pulmonary Disease |
|
SOB |
Shortness of Breath |
|
LFT’s |
Liver Function Tests |
|
RFT’ |
Renal Function Tests |
|
IBS |
Irritable bowel syndrome |
|
ECG |
Electrocardiography |
|
RBS |
Random blood sugar |
|
CBC |
Complete Blood count |
|
ESR |
Erythrocytes sedimentation rate |
|
DM |
Diabetes mellitus |
|
CLD |
Chronic Liver Disease |
|
CCF |
Congestive Cardiac failure |
|
SGPT |
Serum glutamic pyruvic transaminase |
|
HTN |
Hypertension |
|
CVA |
Cerebrovascular accident |
List
of tables:
|
Table No |
Title |
Page No |
|
Table 4.1 |
Demographic data |
14 |
|
Table 4.2 |
Age wise group distribution |
14 |
|
Table 4.3 |
Dosage form prescribed |
15 |
|
Table 4.4 |
Frequency and percentages of
prescribed antibiotics |
15 |
INTRODUCTION
A
drug which is used to treat bacterial infections is termed as antibiotic.
Antibiotics have no effect on viral infections. Originally, an antibiotic was a
substance produced by one microorganism that selectively inhibits the growth of
another. Synthetic antibiotics, usually chemically related to natural
antibiotics, have since been produced that accomplish comparable tasks (Cowan
M.M., 1999).
In
1926, Alexander Fleming discovered penicillin, a substance produced by fungi
that appeared able to inhibit bacterial growth. In 1939, Edward Chain and
Howard Florey further studied penicillin and later carried out trials of
penicillin on humans (with what were deemed fatal bacterial infection).
Fleming, Florey and Chain shared the Nobel Prize in 1945 for their work which
is shared in the era of antibiotics (bud R., 2007).
Antibiotics are the most widely and the only
class of drugs prescribed. Information related to the usage of it not important
only due to the price of its misuse but as will due to the cost of it, in
hospital especially, may be unnecessary mortality and morbidity,
hospital increased rates of infection and fast obsolescence of most of the
premium drugs (Jackson G et al., 1979). Antibiotic previous surveys, use in hospital
(Scheckler WE et al., 1970, Rebecca K et al.,1965). On the bases of derived
information indirectly. Only one is refers to U.K. In certain medical wards
that was restricted to patients (Lawson DH et al., 1977). Audit of antibiotic
as a process of influencing prescribing antibiotics in the practice of hospital was suggested by a Lancet editorial. They snap a
review or "audit" about the usage of these drugs throughout the
general hospitals in the district on the bases of prescriber’s interviews.
There results suggested that there is a demand to improve the policies of
antibiotic as on the basis for influencing practices of prescribing antibiotic (Flenley, D.C et al., 1981).
The
assessment and evaluation of the care quality of health is receiving attention
globally (Marry et al., 2006). While giving credibility to it because medicines
play a very important role in the health care system (Odusanya and Bamgbala.,
1999). Knowledge upon the quality of healthcare have been needed by healthcare
professionals, the general public and the policy makers (Pont et al., 2004).
The
variation in prescribing behavior, the margins of substantial administrative
databases and co-morbidities have biases identified that are maybe different in
pharmacoepidemiological researches or may show themselves constantly in
researches like these (Mahyar et al., 2006).
Antibiotics
prescribing can be an uncomfortable decision which is reflected in the broad
variation in prescribing rates for respiratory tract infections. Many general
physicians feel that antibiotics may be of some help with potential individual
benefit outweighing any risk from resistant bacteria (butler cl et al., 1998).
Then often the development of cost or resistance to the practice is not
considered (Hamm RM et al., 1996). And to prescribe an antibiotic this decision
needs less information than the decision not to prescribe (Howie JGR et al.,
1974). A strategy that can help this quandary without harm to the patient would
be of considerable value for practitioners who are unwilling to deny the demand
they perceive from patients.
For
consulting of general practitioner acute respiratory tract infection is the
commonest reason, and for their treatment courses of over thirty millions of antibiotic
has been suggested (Macfarlane JT et al., 1997). Despite this management, adult
patients for the treatment of lower respiratory tract infection up to a quarter
of them comes again to consult with their doctor, and to many of them further
course of antibiotic have been suggest, because their doctor may predict about
infection continuing (Verheij TJM et al.,
1989, Venkatesan P et al., 1995). Researchers suggested that the reason is not active infection then why lower
respiratory tract infected patients goes back to re consult, and in a reported
research which include a case-control group, they checked up that whether there
is direct or indirect proofs of persisting or new infections which may justify
to prescribe further antibiotic in adult subjects with the infection of lower respiratory
tract in general practice after the initial antibiotic treatment.
The
goal to reduce the therapy of antibiotics, the antibiotic stewardship programs
are held, thereby confirming the good outcomes clinically while reducing the
expansion of the resistance of antibiotics (Lim CJ et al., 2014, Smith PW et
al., 2008). The application of these programs has been suggested in the light
of world widely enhancement of the resistance of antibiotic and association
between antibiotic usage and the emergence of antibiotic resistance (Spellberg
B et al., 2013, Dellit TH et al., 2007). Antibiotic stewardship activities
examples include feedback and audit, pre-authorization, formulary restrictions,
guideline and education development. Whereas antibiotic stewardship program are
mainly being applicate in hospital care, and relatively they are new to the
setting of long-term care (Lim CJ et al., 2014, Smith PW et al., 2008). This
setting puts the community at high threat of developing infections due to, for
example, invasive device use, immune function declined, shared social and
dining exertions, and relevantly contact closely with the workers of healthcare.
In this setting and part of this practice the commonly prescribed antibiotic
are potentially inappropriate (Smith PW et al., 2008, Van Buul LW et al., 2012).
Certain studies have been evaluated intervention about antibiotic prescribing
to optimize it in long-term care facilities (Lim CJ et al., 2014, Fleming A et
al., 2013, Zimmerman S et al., 2014). These studies varied depending on the
type of intervention, the results measured, and the outcome. Because of this diversity and some methodological
limitations, the two comments reported that the evidence on the impact of a
particular intervention was not conclusive (Lim CJ et al., 2014, Fleming A et al.,
2013). While intervention may have been limited in these studies because of
pre-determined opportunities, intervention may be effective in some situations
but not in others (Forsetlund L et al., 2011, Arnold SR et al., 2005). Indeed,
antibiotic prescription decisions actually depends on certain local factors
that might differ between LTCFs. In qualitative studies, the researchers find
that the prescribing behavior of antibiotic of LTCFs is measured by the
clinical situation, the treatment plan, the use of diagnostic resources, the
physician's perceived risk, and the influence of others (e.g. nursing staff and
family members) and certain factors of environment (e.g. guidelines availibility)
(Van Buul LW et al., 2014). Antibiotic prescription remediation programs are
likely to be effective if those features are considered when developing a
program (Lim CJ et al., 2014, Hulscher MEJL et al., 2010, Arnold SR et al., 2005,
Schouten JA et
al., 2007, Pronovost PJ et al., 2013). In addition to dealing
with resident initiators and barriers, participation by resident participants
can help develop a quality improvement program for health care (Grol RPTM et
al., 2007). We therefore hypothesized that the Participatory action research
(PAR) is the appropriate method for developing an antibiotic effective
stewardship program (Van Buul LW et al., 2014). PAR is a method of research
characterized by the participation of resident participants in identifying
opportunities for the practice to be improved, the progress and application of
customized intrusions for these opportunities, and the implementation of intrusions.
The research examine the effectiveness of personalized intrusions developed
with the PAR method to the relevance of choices to prescribe or suspend the
antibiotics in the Netherlands's NH (called "prescription
decisions"). In this way, the researchers studied the effects of the usage
of antibiotic and the parameters related to the selection of antibiotics (Van
Buul LW et al., 2014).
Aims and Objectives:
·
To measure the consequences of the
conditions and,
·
To indicate remedial procedures for the
control of the usage of antibiotics.
·
To assess the configuration of prescribing
medications and,
·
The practice of consultants related
especially to antibiotics.
LITERATURE
REVIEW
Antibiotics
are one of the most frequently prescribed drugs in modern medicine. Antibiotics
treat diseases by killing or hurting bacteria. The first antibiotic was the
penicillin found by chance in mold. Today, more than 100 antibiotics can cure
small, life-threatening infections (Levy, S.B.,
2013).
Most
general doctors decided that antibiotics are preventable for most of the
subjects infected by microorganisms. They have clarify it clearly in different
ways like investigation, researches, prescribing advisers locally and country gossips
(wise R et al., 1998). That have affected antibiotic prescription reduction.
General prescribers have described various approaches to limit antibiotic
prescriptions for microbial infections. The majority found that microbial
infection counseling was common, time consuming, and likely to cause
inconsistencies (wise R et al., 1998).
Antibiotics
were given to 95 of the 184 (51.6%) patients, mainly children <3 years
(40/95). Amoxicillin (37/95) was the most frequently prescribed antibiotic,
followed by beta-lactam/beta-lactamase combination and second-generation
cephalosporins. Fever, younger age, sore throat and presence of earache
increased the likelihood of antibiotic prescription. Data from the
cross-sectional survey of doctors revealed that lack of national guidelines,
parental pressure and diagnostic uncertainty contributed to antibiotic overuse (Senok et al., 2009).
A study reported that the most
frequently prescribed antibiotics were penicillins (amoxicillin [46.3%] and
amoxicillin/clavulanate [5.3%]) and a macrolide (erythromycin [6.1%]). The
three symptomatic agents most frequently prescribed were paracetamol [40.1%];
diphenhydramine [29.1%]; and normal saline nasal drops [14.2%]. In 112 cases
with swab analyses done, of these, 98.2% revealed a growth of commensals only,
while 1.8% grew pathogenic micro-organisms. Of the cases showing commensal
growth only, 84.6% were treated with an antibiotic, 14.5% were treated with
symptomatic agents alone and 0.9% received no drug therapy at all (Mungrue et al., 2009).
A study, analyzing
497 prescriptions, reported that the average number of drugs per encounter in
the facility was 3.04. Generic prescribing was low at 42.7 % while antibiotic
prescription was high at 34.4%. Injections were prescribed in 4% of encounters.
The study concluded that polypharmacy, low rate of generic prescriptions and
overuse of antibiotics still remain a problem in health care facilities in
Nigeria.. This calls for sustained interventional strategies and periodic audit
at all levels of health care to avoid the negative consequences of
inappropriate prescriptions (Tamuno I et al., 2012).
A
study from Lahore, Pakistan reported, while analyzing 4923 cases, that the
average number of drugs per prescription is 3.13 ± 1.5. About 143 prescriptions
were found to have at least an injection and while 1007 cases were prescribed
with at least one antibiotic (Riaz H et al., 2011).
A
study conducted on 61 prescriptions reported that amoxycillin was the most
widely prescribed antibiotic (148/191 [77.5%]). Satisfaction with all aspects
of counseling and treatment was high such as about 90% of the total subjects
were very satisfied. However, there were more dissatisfied ('not at all' or
completely dissatisfied) with treatment in the delayed group (13%). There was
no difference in satisfaction with the advice or information received about the
treatment. Immediate group of patients was more activated by experience
(Patient Availability Index: mean, quartile range 3.3 vs 2.4. (Dowell J et al.,
2001).
General
practitioners treated respiratory infections in 440 patients during seven
winter months. Seventy three patients (age 53, male 40%) was reluctant or
unable to participate, no research nurse, or another reason. Detailed
information about the cohort of 367 patients examined is displayed. The most
common leading disease was chronic lung disease (82 patients) and heart disease
(45 patients). There were 49 (13%) patients with subjective disease severity
scores. The patient's score was 54% higher than the doctor's score (often
recording the problematic symptoms), compared with 43% and 3%. Amoxycillin was
prescribed to 333 patients (91%); 29 (8%) received erythromycin and 5 (1%)
received other antibiotics.
A
study reported, while cultivating only six samples of ampicillin-sensitive
bacterial pathogens, that twenty-seven atypical infections were serologically
diagnosed, the most common being Chlamydia pneumoniae. No detection of
Chlamydia infection was found in the throat swab by the poly-laminate chain
reaction. 46 out of 54 patients were found with viral infection and of these, 21,
9, & 25 were diagnosed with sequential serologic tests, virus cultures, &
polymerase chain reactions respectively. Only 3 out of 39 patients who thought
that they had persistent infection due to consultation and antibiotic treatment
were dependable with infection on the X-ray of chest and only 3 patients showed
C-reactive protein concentration of 40 mg per one or more (Macfarlane J et al.,
1997).
METHODOLOGY
3.1 Study area and
period:
A
60 days clinical research study was performed in Medical A, B and C wards of
Mardan Medical Complex Mardan, KPK. Research study started from 1 January 2017
to March 2, 2017. The hospital serves as a referral
hospital to the patients from different parts of Mardan region and other nearby
regions such as Swabi, Malakand, Bunir and other neighborhood.
3.2 Study design:
A concurrent cross-sectional hospital-based research study was
conducted with hospitalized patients.
3.3 Study population:
Medical record charts of patients who were admitted to all wards
during the study period were included in the study.
3.4 Inclusion
criteria:
Patients who were taking two or more drugs concurrently for at
least 48 hours were included.
3.5 Exclusion
criteria:
·
Patients who were taking
two or more drugs but not concurrently;
·
Incomplete patient medical
records;
·
Hospital stay of fewer
than 48 h;
During
the mentioned period total 500 prescriptions were collected and were analyzed
for consultant behavior about antibiotics prescribing male and female ratio,
frequency and percentage of the prescribed medications and age wise percentage.
Table 1. Demographic data:
|
Gender |
No
of patients |
%age |
No
of drugs prescribed |
|
Male |
|
|
|
|
Female |
|
|
|
|
Total |
|
|
|
Table 2. Age wise group
distribution:
Age groups in years:
|
Gender |
1
to 20 |
21
to 40 |
41
to 60 |
61
to 80 |
81
to 100 |
|
Male |
|
|
|
|
|
|
Female |
|
|
|
|
|
|
Total |
|
|
|
|
|
Table 3. Patient Demographic History:
|
Patient’s
Name |
|
Physician/Doctor |
Dr. |
||
|
Gender |
Age |
|
|
Ward/Unit |
|
|
Weight
in Kg/Lb |
|
Admission/B.No |
|
||
|
Height
in Ft.Inches |
|
Interview
date |
|
||
|
Address |
|
Date
of Admission |
|
||
|
Ethnics
or Religion |
|
Date
of Discharge |
|
||
|
Patient
Occupation |
|
|
|
||
Table
4. Chief Complaints:
|
Complaints |
Comments |
|||
|
1 |
|
|
|
|
|
2 |
|
|
||
|
3 |
|
|
||
|
4 |
|
|
||
Table 5. Laboratory Data :(
mentions details; state whether positive or negative.)
|
Biochemical
tests advised: |
Results |
Normal
Ranges |
Remarks |
|||
|
1 |
|
|
|
|
||
|
2 |
|
|
|
|
||
|
3 |
|
|
|
|
||
|
4 |
|
|
|
|
||
|
5 |
|
|
|
|
||
Table
6. Diagnosis:
|
Diseases
Diagnosed |
Comments |
||
|
1 |
|
|
|
|
2 |
|
|
|
|
3 |
|
|
|
|
Concurrent
ailments / Diseases |
|
||
|
1 |
|
|
|
|
2 |
|
|
|
|
3 |
|
|
|
Table 7. Frequencies and percentage
of the prescribed antibiotics
|
Prescribed
Antibiotics |
Frequencies |
Percentage |
|
Total
No. of Antibiotics prescribed. |
|
|
|
Antibiotic
mostly prescribed |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
RESULT AND DISCUSSION
4.1
Results:
4.1.
Demographic data:
Out
of total 500 prescriptions, 270 (54%) were male patients and 230 (46%) were
female patients which were prescribed with 1923 and 1850 drugs respectively (Table
1).
Table
1. Demographic data:
|
Gender |
No of patients |
Percentage |
No of drugs prescribed |
|
Male |
270 |
54% |
1923 |
|
Female |
230 |
46% |
1850 |
|
Total |
500 |
100 |
3773 |
4.2.
Age wise group distribution:
Out
of 500, the ages of 35 patients were found within the range of 1-20 years, 245
patients were found within the range of 21-40 years, 140 patients were found
within the range 41-60 years, 60 patients were found within the range of 61-80
years and 20 patients were found within the range of >80 years (Table 2).
Table 2. Age wise group
distribution:
Age groups in years:
|
Gender |
1
to 20 years |
21
to 40 years |
41
to 60 years |
61
to 80 years |
>80 years |
|
Male |
21 |
140 |
80 |
19 |
10 |
|
Female |
14 |
105 |
60 |
41 |
10 |
|
Total |
35 |
245 |
140 |
60 |
20 |
4.3.
Dosage form nature and pattern of antibiotics
Regarding dosage form, the injectable [2215
(58.7%)] were more commonly prescribed, followed by tablets [900 (23.8%)], syrup
[290 (7.7%)], capsules [150 (4%)], aerosol [118 (3.1%)] and suspension [100
(2.7%)] (Table 3).
In
a total of 500 prescriptions, 700 antibiotics were identified. Of these,
ceftriaxone [260 (37.1%)] is the most common prescribed antibiotic, followed by
moxifloxacin [85 (12.1%)], Amoxicillin [70 (10%)], azithromycin [60 (8.5%)],
levofloxacin [50 (7.1%)], piraxicame [50 (7.1%)], ciprofloxacin [45 (6.4)] and
clarithromycin [40 (5.7%)] (Table 4).
|
Antibiotics |
n |
% |
Antibiotics
|
n |
% |
|
Ceftriaxone |
260 |
37.1 |
Amoxicillin |
70 |
10 |
|
Moxiflaxacin |
85 |
12.1 |
Piroxicam |
50 |
7.1 |
|
Ciprofloxacin |
45 |
6.4 |
|
|
|
|
Clarithromycin |
40 |
5.7 |
|
|
|
|
Azithromycin |
60 |
8.5 |
|
|
|
|
Levofloxacin |
50 |
7.1 |
|
|
|
|
Total |
|
|
|
700 |
100
|
Table
3. Dosage forms nature: Table
4. Pattern of antibiotics
|
Dosage forms |
Frequency (%) |
|
Injectable |
2215
(58.7) |
|
Tablets |
900 (23.8) |
|
Capsules |
150 (04.0) |
|
Suspensions |
100 (02.7) |
|
Syrup |
290 (07.7) |
|
Aerosol |
118 (03.1) |
|
Total |
3773 (100) |
4.2 Discussion:
In
current study, ceftriaxone (37.1%) is the most common prescribed antibiotic, in
comparison, this result was quiet different than the study conducted in Dundee
by Dowell J et al (2001). where amoxicillin (77.5%) was the most common
prescribed antibiotic and similar result was found by Macfarlane J et al (1997).
from Nottingham, Finland that makes the evidence of amoxicillin (91%) abundance
prescribing. The current study found
that ceftriaxone (37.1%) was the most common prescribed antibiotic followed by
moxifloxacin (12.1%), Amoxicillin (10%), azithromycin (8.5%), levofloxacin
(7.1%), piraxicame (7.1%), ciprofloxacin (6.4) and clarithromycin (5.7%). This
result was quite different from findings of Aabenhus et al (2017). that penicillin V (58%) was the
most common antibiotic in practice, followed by macrolides (18%) and
amoxicillin (15%). Similarly the result of the current study contrasted the
findings of an another study conducted in Isfahan, Iran by Safaeian
et al (2015). which found penicillin as an abundant class of antibiotic,
followed by cephalosporins and macrolides. The pattern of antibiotics
identified at this hospital suggest the overuse of antibiotics, which may
enhance the cost of therapy, and develop the resistance to particular
antibiotic or class of antibiotics. The ceftriaxone is the mostly prescribed
antibiotic, because it is broad spectrum but its use may enhance the cost of
therapy. The prescribers use broad spectrum antibiotics only, as empirical
therapy, instead of to advice culture test or microscopy for a specific
bacteria to cover that pathogen only with narrow spectrum antibiotics that have
less potential for adverse effects. The broad spectrum antibiotics may disturb
the normal flora of the body and results in further complications. Similarly
broad spectrum antibiotics, like ceftriaxone, have more chances for drug-drug
interactions. So alternative shall be advised, if proper diagnosis for specific
pathogen as possible, which will be cost effective and will has minimum side
effects as compared to the broad spectrum antibiotics.
4.3
Conclusion:
From
our current study, we conclude that the most commonly prescribed antibiotic is
ceftriaxone following moxifloxacin, amoxicillin, azithromycin and
clarithromycin diagnosed. There is polypharmacy, prescription by non-generic
names, overuse of antibiotics, overuse of injections and incompliance with WHO
drug list. The report strongly recommends the urgent evaluation, monitoring and
intervention to the policy makers and managers for the purpose to promote the
rational therapy and further suggests that the proper communication means could be devised including regular
forums for discussion on rational drug use between prescribers and pharmacists.
REFERENCES:
Aabenhus, R., Hansen, M.P., Saust, L.T. and
Bjerrum, L., 2017. Characterisation of antibiotic prescriptions for acute
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