ObjectivesTo present and compare antibiotic prescribing for inpatients among the most common non-bacterial diagnoses groups at medicine departments of a teaching (TH) and a non-teaching hospital (NTH) in central India.SettingAn observational cross-sectional study was conducted at two tertiary care settings in Ujjain district, Madhya Pradesh, India.Data and participantsThe data were collected manually, using a customised form. Complete records of all inpatients, who were >15 years of age and had stayed for at least one night in either of the hospitals during 2008–2011, were analysed.Outcome measuresInpatients were grouped according to the presence or absence of a bacterial infectious diagnosis, viral/malaria fever or cardiovascular disease. Classes of antibiotics prescribed to these groups and adherence to the available prescribing guidelines were compared between the hospitals using the notes from the patient files and the diagnoses.ResultsOf 20 303 inpatients included in the study, 66% were prescribed antibiotics. Trade name prescribing and use of broad-spectrum antibiotics were more frequent at the NTH than at the TH (p<0.001). At the TH a significantly higher proportion of patients having fever without registered bacterial infection were prescribed antibiotics (82%) compared with the NTH (71%, p<0.001). Patients admitted for cardiovascular diagnosis without registered bacterial infections received antibiotic prescriptions at both hospitals (NTH 47% and TH 37%) but this was significantly higher at the NTH (p<0.001). None of the diagnoses were confirmed by microbiology reports.ConclusionsPrescribing antibiotics, including broad-spectrum antibiotics, to inpatients without bacterial infections—that is, viral fever, malaria and cardiovascular disease, was common at both hospitals, which increases the risk for development of bacterial resistance, a global public health threat. In view of the overprescribing of antibiotics, the main recommendations are development and implementation of local prescription guidelines, encouragement to use laboratory facilities and prescription analysis, with antibiotic stewardship programmes.

Background: Patients admitted to obstetrics and gynaecology (OBGY) departments are at high risk of infections and subsequent antibiotic prescribing, which may contribute to antibiotic resistance (ABR). Although antibiotic surveillance is one of the cornerstones to combat ABR, it is rarely performed in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients in OBGY departments of two tertiary care hospitals, one teaching (TH) and one nonteaching (NTH), in Central India. Methods: Data on patients’ demographics, diagnoses and prescribed antibiotics were collected prospectively for three years. Patients were divided into two categories- infectious and non-infectious diagnosis and were further divided into three groups: surgical, nonsurgical and possible-surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system, and the International Classification of Disease system version-10 and Defined Daily Doses (DDDs) were calculated per 1000 patients. Results: In total, 5558 patients were included in the study, of those, 81% in the TH and 85% in the NTH received antibiotics (p < 0.001). Antibiotics were prescribed frequently to the inpatients in the nonsurgical group without any documented bacterial infection (TH-71%; NTH-75%). Prescribing of broad-spectrum, fixed-dose combinations (FDCs) of antibiotics was more common in both categories in the NTH than in the TH. Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: Antibiotics were frequently prescribed to the patients with no documented infectious indications. Misprescribing of the broad-spectrum FDCs of antibiotics and unindicated prescribing of antibiotics point towards threat of ABR and needs urgent action. Antibiotics prescribed to the inpatients having nonbacterial infection indications is another point of concern that requires action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve antibiotic prescribing practice.

Background: Patients in obstetrics and gynaecology (OBGY) departments are at high risk of life-threatening infection, thus prescribed antibiotics extensively. The use of antibiotics leads to increasing antibiotic resistance (ABR). Antibiotic surveillance is one of the cornerstones to combat ABR. However, surveillance of, department specific antibiotic prescription data is rarely performed, especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH), in Central India. Methods: A prospective study was conducted for three years using. Demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration and frequency were recorded for all inpatients during their hospital stay. The patients were divided into, infectious and non-infectious diagnosis categories and further into surgical, non-surgical and possible surgical indications using the International Classification of Disease system version-10. Results: A total of 5558 patients were included in the study; 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotics (p<0.001). A majority of the patients with surgical indications were prescribed antibiotics (TH-87%, NTH-100%). Prescribing of the fixed-dose combinations (FDCs) of antibiotics and use of trade names were more common at the NTH. Most of the inpatients who had neither surgery nor any confirmed bacterial infection received antibiotics (TH-71% and NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: High antibiotic prescribing for the inpatients having no infection indications in both hospitals, as well as frequent prescribing of trade-name, broad-spectrum antibiotics, including the FDCs in the NTH than the TH, are points of concern. Investigation of the underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the antibiotic prescribing practice.

Background : Patients in departments such as obstetrics and gynaecology (OBGY) are at high risk of life-threatening infections, thus are prescribed antibiotics extensively. Use of antibiotics leads to increasing antibiotic resistance. Antibiotic surveillance is one of the cornerstones to combat antibiotic resistance. However, hospital-based, department specific surveillance data of prescribed antibiotics are scarce, especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescribing patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH), in Central India. Methods: Data of all inpatients was collected manually for three years and analysed using demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration, and frequency and defined daily dose per 1000 inpatients were calculated. The patients were divided into, infectious and non-infectious categories and further into surgical, non-surgical and possible surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system and the International Classification of Disease system version-10. Results: Of the total 5558 admitted patients, 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotic treatment (p<0.001). In both hospitals, a majority of the patients with surgical indications were prescribed antibiotics (87% to 100%). Prescribing of the fixed-dose combinations of antibiotics (FDCs) and use of brand names was more common at the NTH then at the TH. A majority of the inpatients who neither had surgery nor had any confirmed bacterial infection also received antibiotic prescriptions (TH-71%, NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH compared to the NTH in both categories. Conclusions: More frequent prescribing of broad-spectrum antibiotics, including FDCs and higher brand-name prescribing at the NTH compared to the TH, is a point of concern. Antibiotics prescribed to the inpatients having non-bacterial infection indications is another point of concern and requires urgent action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the prescribing of antibiotics.

Background: Patients in departments such as obstetrics and gynecology (OBGY) are at high risk of life-threatening infections, thus are prescribed antibiotics extensively. Use of antibiotics leads to increasing antibiotic resistance. Antibiotic surveillance is one of the cornerstones to combat antibiotic resistance. However, hospital-based, department specific surveillance data of prescribed antibiotics are scarce especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescribing patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH) in Central India. Methods: Data of all inpatients was collected manually for three years and analyzed using demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration, and frequency and defined daily dose per 1000 inpatients were calculated. The patients were divided into, infectious and non-infectious categories and further into surgical, non-surgical and possible surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system and the International Classification of Disease system version-10. Results: Of the total 5558 admitted patients, 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotic treatment (p<0.001). In both hospitals, a majority of the patients with surgical indications were prescribed antibiotics (87% to 100%). Prescribing of the fixed-dose combinations of antibiotics (FDCs) and use of brand names was more common at the NTH then at the TH. A majority of the inpatients who neither had surgery nor had any confirmed bacterial infection also received antibiotic prescriptions (TH-71%, NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH compared to the NTH in both categories. Conclusions: More frequent prescribing of broad-spectrum antibiotics including FDCs and higher brand-name prescribing at the NTH compared to the TH is a point of concern. Antibiotics prescribed to the inpatients having non-bacterial infection indications is another point of concern and requires urgent action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the prescribing of antibiotics.