Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India

Abstract

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.