A prospective antibacterial utilization study in pediatric intensive care unit of a tertiary referral center

Abstract

Purpose:Antibacterials are commonly prescribed to Pediatric Intensive Care Unit (PICU) patients. However, inappropriate antibacterial prescriptions lead to increases in antibacterial resistance, treatment cost, duration of treatment, and poor clinical outcome. The antibacterial utilization study assesses the prescription patterns and if necessary recommends the interventions to improve antibacterial prescriptions. Hence, the present prospective groundwork was conducted.Materials and Methods:The study was conducted over the period of 6 months (April 18 to October 20, 2014). The demographics and drug use details were captured daily from patients admitted to PICU to assess World Health Organization indicators.Results:A total of 200 patients enrolled, among them 119 males and 81 females. There were 12.46 (±6.16) drugs prescribed per patient, of which 2.38 (±1.48) were antibacterials. Among the total drug prescribed, 18.49% were antibacterials and 97% patients received at least one antibacterial. Ceftriaxone (49.48%) was the most commonly prescribed antibacterial, while imipenem (2.58%) and colistin (2.06%) use was very low. A total of 80.95% antibacterials were prescribed by generic name, 94.88% were administered intravenously, and 80.76% were prescribed from hospital pharmacy. The average length of PICU stay was 6.15 days (±6.20), the average length of antibacterial treatment was 6.08 days (±6.27), and the average length of empirical antibacterial treatment was 5.50 days (±5.40). The cost of antibacterial therapy per patient was Indian rupees 824.64 (±235.35). In 27 patients, bacterial culture test was positive and of whom 21 received antibacterials as per sensitivity pattern.Conclusions:The use of antibacterials was not indiscriminately high but more prescriptions per sensitivity pattern are required.

Evaluation of antibiotic prescribing pattern in pediatrics in a tertiary care hospital

“…This study revealed the mean duration of antibiotic therapy as 5.90 days ± 3 days with similarities observed with Mali et al [ 27 ] (6.08 days±6.27 days).…”

Drug utilisation in adult, paediatric and neonatal intensive care units, with an emphasis on systemic antimicrobials

“…Irrespective of age group, most of the drugs were administered parenterally followed by the oral route ( Table 3). The median (IQR) for the total number of drugs per encounter was significantly different (P = 0.0001) between adult, paediatric and neonatal ICUs: 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)…”

“…Children and neonates are prone to adverse drug reactions considering the developmental changes in their organs, and most of these drugs have not been tested in this subpopulation. In a recent study from the paediatric ICU of a developing country, almost 98% received at least one antimicrobial, of which ceftriaxone was the most administered [ 9 ]. A recent systematic review of drug utilisation studies (DUS) in critically ill neonates revealed that they had been carried out only in a few countries such as Brazil ( n = 1), the EU ( n = 7), India ( n = 5), Iran ( n = 1) and the USA ( n = 6) [ 10 ].…”

A cross sectional observational study to evaluate utilization of antimicrobials in paediatric department of a tertiary care teaching hospital

“…Antimicrobials use amongst them should receive special attention as they are prone to increased risk of exposure to resistant strains in the later stages of their life. 5 Currently there is global increase in AMR and considerable shortfalls in the development and availability of new antimicrobials. Therefore, implementing measures to maintain the usefulness of existing antimicrobial agents has become a top public health concern.…”