Antibiotic Prescribing Practice in Chronic Kidney Disease Patients in a Tertiary Care Teaching Hospital: Analysis Based on 2019 WHO AWaRe Classification

Abstract

Chronic kidney disease (CKD) patients are prone to infections and inevitably require antibiotics. Antimicrobial resistance (AMR) is a global threat to humans. Indeed, the most important cause for spread of AMR is irrational use of antibiotics. Therefore, the present study evaluates prescribing practice of antibiotics in CKD patients. A cross-sectional study was carried out in 382 CKD in-patients prescribed with antibiotics. The data were analysed using the WHO prescribing indicators and the WHO Access, Watch, and Reserve (AWaRe) classification. The average number of drugs prescribed per encounter was 3.1. Antibiotics prescribed by generic name and prescribed from the Essential Medicines List were 52.9% and 47.1%, respectively. % Encounters with antibiotics and parenteral antibiotics were 59.2% and 77.4%, respectively. Third generation cephalosporins (76.9%), particularly cefoperazone (40%) and ceftriaxone (21.2%), were the most commonly prescribed antibiotics. A total of 19 specific antibiotics (Access 5, Watch 13, Reserve 1, and Not Recommended 0) were prescribed. According to WHO AWaRe classification, 10.6%, 89%, and 0.4% of antibiotics prescribed were from the ‘Access’, ‘Watch’, ‘Reserve’ categories, respectively. ‘Watch’ category antibiotics, particularly cephalosporins (98%), were prescribed in high rate. The most commonly prescribed ‘Access’ and ‘Watch’ category antibiotics were amikacin (37%) and cefoperazone (44.9%), respectively. Amoxicillin index was 1.6 and ‘Access-to-Watch’ index was 0.1, which were below the priority values. Prescription pattern of antibiotics observed in this study was not fully met the WHO recommendations. Additionally, ‘Watch’ category antibiotics, particularly cephalosporins, were prescribed frequently. Changes in prescription pattern and monitoring of antibiotic use are essential to preserve effectiveness and promote rational use of antibiotics, and to overcome AMR.

Emergence of Third Generation Tetracyclines: New Magic Bullets to Tackle Antibiotic Resistance in the Post-antibiotic Era

“…It is highly essential to use antibiotics prophylactically in hospitalized patients for various surgeries, therapeutically in primary care settings for various community-acquired infections (CAIs), to prevent and treat infections in various invasive procedures and hospital acquitted infections (HAIs) adhere to international, national and hospital antibiotic use policies [7][8][9][10]. "Moreover, antibiotic use is compulsory in certain unavoidable clinical conditions, such as sepsis and in immunocompromised patients who are at risk of developing mixed infections" [9][10][11][12].…”

“…It is highly essential to use antibiotics prophylactically in hospitalized patients for various surgeries, therapeutically in primary care settings for various community-acquired infections (CAIs), to prevent and treat infections in various invasive procedures and hospital acquitted infections (HAIs) adhere to international, national and hospital antibiotic use policies [7][8][9][10]. "Moreover, antibiotic use is compulsory in certain unavoidable clinical conditions, such as sepsis and in immunocompromised patients who are at risk of developing mixed infections" [9][10][11][12]. "Inarguably, when there are no clinical practice guidelines, there is a need and necessary to use antibiotics for prophylactic as well as therapeutic purposes in the recent unprecedented pandemic time due to coronavirus disease (COVID- 19) and in multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2, the virus that causes COVID-19" [11,12].…”

“…Microbes resistant to multiple antimicrobials (at least three different classes of antimicrobials) are called multidrug-resistant (MDR). Those bacteria that are considered extensively drug-resistant (XDR) or totally drug-resistant (TDR) are sometimes called 'superbugs' [8,9,21]. "There is a high risk of entering into a "post-antibiotic era", a period in which bacteria have become resistant to existing antibiotics and the antibiotics no longer work" [13,22].…”