Background: Aim of the study was to assess trend in antibiotics consumption pattern from 2016 to 2019 using AWaRe classification, ATC and Defined daily dose methodology (DDD) in a tertiary care hospital. Antibiotics are crucial for treating infectious diseases and have significantly improved the prognosis of patients with infectious diseases, reducing morbidity and mortality. The aim of the study is to classify the antibiotic based on WHO AWaRe classification and compare their four-year consumption trends. The study was conducted at a tertiary care center, Pilakhuwa, Hapur. Antibiotic procurement data for a period of 4 years (2016-2019) was collected from the Central medical store.Methods: This is a retrospective time series analysis of systemic antibiotics with no intervention at patient level. Antibiotic procurement was taken as proxy for consumption assuming that same has been used.  ATC for systemic use (ATC code J01) antibacterial was used and defined daily dose (DDD) per 100 bed days was calculated. Antibiotics were further classified as Access, Watch, and Reserve (WHO AWaRe classification).  Antibiotics consumption was ranked based on their volume of DDD i.e., drug utilization (DU90%) was calculated. Non-parametric Pearson’s correlation coefficient was used for the comparison of consumption.Results: Mean antibiotic procurement increased 1.25 folds from 140.3 DDD in 2016 to 201 DDD in 2018. A significant fall was seen in total DDDs in year 2019 (p value <0.05). A total of 41 antibiotics agents (Access 12, Watch 21, Reserve 6 and Not recommended 2) were procured. Reserve category antibiotics were procured from 2017 onwards. Out of 41 antibiotics procured 11 antibiotics (Access 3 and watch 8) accounted for DU 90%.Conclusions: Antibiotics consumption of watch group was high and increasing antibiotic consumption trend was observed. Hospital antimicrobial stewardship program should be implemented to shift to use of Access group antibiotics and restrict use of Watch antibiotics.

Adrenal crisis is a rare life-threatening medical endocrine emergency with non-specific insidious symptoms and challenging diagnosis. An appropriate timely diagnosis and treatment can save life. Although most doctors are educated by “sick day rules,” but are reluctant to start glucocorticoids, increase doses or switch to parental injections. Our case report highlights various aspect of adrenal crisis.