Antibiotic Prescription Pattern in Surgical Wards of MGM Hospital, Kamothe

Abstract

Background: Surgical antimicrobial prophylaxis refers to a brief course of antibiotic given just before surgery. Surgical site infection increases the hospital stay and prophylaxis has the potential to shorten hospital stay and fasten return to normal activity after discharge from the hospital. Therefore, the present study was undertaken to observe and analyse antimicrobial prescription pattern in patients that had undergone surgery at a tertiary care hospital. Methods: This was a prospective case series study, with 200 patients irrespective of age or gender, presented to the surgical wards of a tertiary hospital and undergoing surgical intervention, conducted from October 2016 to April 2017. Permission of the institutional ethics committee was obtained before commencement of the study. Data was collected from all patients with the help of predesigned, pretested, and structured questionnaires. By comparison with international guidelines and national guidelines, the antibiotic prescription patterns were assessed. The researchers also observed whether a fixed protocol was followed for antimicrobial use for surgical prophylaxis. Results: Overall, 200 patients were studied, with a mean age of 40.2 and a range of 23 to 70 years old with 64% being males and 36% being females. The surgeries of these patients were hernioplast 36%, PCNL 8%, haemorrhoidectomy 20%, appendicectomy 4%, hydrocoel surgery 16%, lipoma excision 12%, and cholecystectomy 4%. The percentages of antibiotics used for these surgeries were cefotaxime 44%, amikacin 88%, ceftriaxone 52%, metronidazole 30%, and cefixime 54%. These were then compared with the International and National guidelines for surgical prophylaxis. Conclusions: Third generation cephalosporins were the preferred antibiotics for pre-operative use as well as for use in combination with aminoglycoside and metronidazole for better postoperative antibiotic coverage. This seems to be due to multiple factors in Indian settings, which makes Indian practitioners administer antibiotics for a prolonged duration.

Hospital Antibiotic Prescribing Pattern in General Surgery Specialty: Analysis Based on the WHO Access, Watch and Reserve (AWaRe) Classification

“…Aminoglycosides and penicllins were the second and third most frequently prescribed prophylactic antibiotics owing to their broad-spectrum of activity, in particular selectivity for Gram-ve bacteria. Our results are parallel to previous studies which reported a higher prescription and use of third generation of cephalosporins [17,27,28]. On the contrary, few studies reported high prescription of penicillins, amikacin, metronidazole over cephalosporins [22,27].…”

“…Our results are parallel to previous studies which reported a higher prescription and use of third generation of cephalosporins [17,27,28]. On the contrary, few studies reported high prescription of penicillins, amikacin, metronidazole over cephalosporins [22,27]. The disparities in antibiotic selection depends on the type and nature of surgery and local antibiotic policy while some surgeons are accustomed to follow their own protocol, which has always 'worked' for them [6,16].…”

Antibiotics Using Pattern in Surgery Department of a Maternity and Children Hospital

“…Sane et al [2] stated that in surgical wards, the percentages of antibiotics used for these surgeries were cefotaxime 44%, amikacin 88%, ceftriaxone 52%, metronidazole 30%, and cefixime 54%. Herawati et al [18] reported that in the Surgery Department of Bangil Regional General Hospital, Pasuruan, the 3 most-used antibiotics are ciprofloxacin (11.8 DDD / 100 patient-days), ceftazidime (6.7 DDD / 100 patient-days), and cefixime (4.3 DDD / 100 patient-days).…”

“…Antibiotics are substances, which are obtained from one microorganism and prove fatal for other microorganism at low concentration and can be either a bactericidal or bacteriostatic agents [2]. Surgical patients are in general high consumers of antibiotics [3].…”

Prevalence of surgical site infections in general surgery in a tertiary care centre in Eastern India

“…27 Third generation cephalosporins were the preferred antibiotics for pre-operative use as well as for the use in combination with aminoglycoside and metronidazole for better postoperative antibiotic coverage. 28 ASA score was significantly associated with SSI development. Results suggest that patients with severe systemic disease (ASA classes III and IV) run a higher risk of SSI than patients with mild or no systemic disease, as supported by previous research.…”