A multicentric, prospective, observational antibacterial utilization study in Indian tertiary referral centers

Abstract

Rationale:Antibacterials are largely prescribed to the intensive care unit (ICU) patients due to high prevalence of infections. However, appropriate use of antibacterials is imperative; since the misuse of antibacterials increases antibacterial resistance and ultimately, it has negative impact on health care and economic system. Hence, continuous antibacterials prescription assessments are very important to judge and improve prescription patterns. The present work was carried out at public and private hospitals to assess the differences in antibacterial prescribing pattern.Methods:The present study was conducted at three public and two private hospitals over the period of 14 months. Demographic and drug use details were captured daily from patients admitted to medical ICUs to assess the World Health Organization indicators.Results:A total of 700 patients were enrolled across the five centers (140 per center), among them 424 were male and 276 were female. Average number of drugs and antibacterials prescribed at public hospitals are significantly higher than the private hospital. However, percentage of antibacterial agents prescribed at public hospitals was significantly lower than the private hospitals (P = 0.0381). Private hospitals had significantly lower percentage of antibacterial agents prescribed by generic name (P < 0.0001). Differences in change of antibacterial agents required were not statistically significantly different (P = 0.1888); however, significant difference was observed in percentage of patients who received antibacterial treatment as per sensitivity pattern (P = 0.0385) between public and private hospitals. Significantly higher mortality was observed in public hospitals compared to private hospitals (<0.0001).Conclusions:More generic prescriptions and more number of prescriptions as per the sensitivity pattern are required at each public and private hospital.

Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study

“…In our study, an average of 8 with a maximum of 18 drugs were prescribed per patient which was comparable or lower to earlier studies conducted in similar settings from India as well as abroad [ 7 , 11 , 15 , 16 ]. Polypharmacy (five or more drugs prescribed) was observed (99%) which was in line with some earlier studies from India [ 17 - 20 ]. Panamanian et al, however, reported only 57% incidence of polypharmacy [ 21 ].…”

“…An overuse of pantoprazole (97% of patients) was observed, a finding in agreement with earlier studies [11,[13][14][15][16][17][18][19][20][21]. Proton pump inhibitors reduce stomach acid output, inhibit upper gastrointestinal hemorrhage, and enhance mucosal healing.…”

“…The most commonly prescribed group of drugs included anti-infectives and drugs acting on the GIT, a finding concordant with many earlier studies [ 9 , 11 , 17 - 20 ]. All the patients had encounters with one or more antibiotics during their ICU stay.…”

“…Due to the wide spectrum of action, favorable safety profile across different age groups, and cost, this group of antibiotics is particularly preferable in ICU patients who are prone to multiple infections due to indwelling devices. In fact, third-generation cephalosporins were the most frequently prescribed antibiotics in various other similar studies [7,9,11,[13][14][15][16][17][18][19][20][21]].…”

Single-dose and Steady-state Pharmacokinetics of Vancomycin in Critically Ill Patients Admitted to Medical Intensive Care Unit of India

“…Despite being an old antibiotic, vancomycin pharmacokinetics (PK) data in critically ill patients are limited and there are no data in Indian population. During our recent observational study, 12 we observed that vancomycin use is 23.23% in medical ICU without support of therapeutic drug monitoring services and evidence of pk data on vancomycin. Hence, present prospective single dose and steady state PK study was conducted in patients with suspected or proven gram-positive bacterial infections admitted to medical ICU.…”