Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Abstract

Background: As evidence is mounting regarding irrational and often unnecessary use of antibiotics during the COVID-19 pandemic a cross-sectional Point Prevalence Survey (PPS) (in accordance with WHO guideline) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH). Methodology: Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH on 11 June 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher’s exact test. Result: Findings reveal all surveyed patients (100%) were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with the severe disease received more antibiotics. Third-generation cephalosporins (i.e. ceftriaxone) (53.8%), meropenem (40.9%), moxifloxacin (29.5%), and doxycycline (25.4%) were the four most prescribed antibiotics among surveyed patients. Diabetes mellitus (DM) was independently associated with multiple antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of multiple antibiotic prescribing among study patients. Conclusion: Prevalence of multiple antibiotic prescriptions was high among severely ill patients and those with abnormal CRP and d-dimer levels. Data regarding the quality of antibiotic prescribing were lacking.

Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

“…In addition, concerns with overuse are documented in the current national guidelines (Box 1). This is similar to the high use of antibiotics among adults admitted to hospital with COVID-19 in Bangladesh 70,71 . This is despite clinicians in most of the surveyed hospitals stating they follow the current national guidelines.…”

“…Having said this, we are aware of the high use of antimicrobials in hospitals including intensive care units in treating patients with COVID-19 despite only a limited number of patients have concomitant fungal or bacterial infections [62][63][64][65][66][67][68][69] . This includes hospitals in Bangladesh 70,71 . As a result, potentially increasing rates of antimicrobial resistance (AMR) with its associated increase in morbidity, mortality and costs 66,[72][73][74][75][76][77] .…”

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

“…A study conducted in the early pandemic period at Wuhan, China reported, all suspected COVID-19 hospitalized cases were treated with empirical antibiotics [ 14 ]. A similar treatment strategy was found in a recent Bangladeshi study where all confirmed COVID-19 patients received one broad-spectrum antibiotic on admission in a tertiary care hospital [ 35 ]. Our study also found a higher number of antibiotic uses among suspected COVID-19 patients.…”

“…Moreover, there is a scarcity of data regarding antimicrobial use among hospital admitted suspected COVID-19 patients in Bangladesh. Available studies reported antibiotic use among confirmed COVID-19 patients, suggesting a wide range of antibiotic use during the COVID-19 pandemic [ 35 , 36 ]. Considering the scarcity of antimicrobial data in this overstressing COVID-19 pandemic situation in Bangladesh, we assessed the proportion of antimicrobial use and factors associated with antibiotic use among suspected COVID-19 patients.…”

​Key findings regarding COVID 19 in Bangladesh and wider and their implications

“…These include encouraging regular hand and addressing environmental hygiene, identification and isolation of patients with COVID-19, surveillance and antibiotic stewardship 38 . Antibiotic stewardship programmes are especially important given the extent of inappropriate prescribing of antibiotics for patients with COVID-19 in Bangladesh and wider, with only a small minority of patients actually having bacterial or fungal co-infections [39][40][41][42][43] . This also includes high prescribing rates for antibiotics among children with COVID-19 in hospitals in Bangladesh despite guidelines advocating more prudent use 44,45 .…”