Antimicrobial drug prescribing patterns for community-acquired pneumonia in hospitalized patients: A retrospective pilot study from New Delhi, India

Abstract

Objective:The objective of this study was to determine patterns and frequency of antimicrobial drug use among hospitalized patients with community-acquired pneumonia (CAP).Methodology:A retrospective 5 years (April 2007–March 2012) detailed medical record review of patients diagnosed with CAP and discharged to home from Non-Intensive Care Unit respiratory medicine wards of two public hospitals in Delhi.Results:A total of 261 medical records were analyzed. Over the 5 years, 82.0% (2007–08), 78.6% (2008–09), 59.5% (2009–10), 64.7% (2010–11), and 67.8% (2011–12) patients were prescribed two antimicrobials. In the last two study years, the proportion of patients receiving three antimicrobials increased (from 2.0% to 26.5% and 28.8%), while the proportion receiving monotherapy decreased (from 16.0% to 8.8% and 3.4%). In accordance with guidelines, beta-lactams and macrolides were the two most frequently prescribed antimicrobials (34.1%). However, newer generation beta-lactams were prescribed. A total of 37 patients were prescribed beta-lactam-tazobactam combination preparations. Overall, beta-lactams constituted more than 40% of prescriptions while macrolides were the second most prescribed class. Cephalosporin prescriptions significantly increased (P < 0.01) and penicillin prescriptions significantly decreased over study periods. The prescription of fluoroquinolones also decreased (21.5–6.0%, P < 0.01) and aminoglycoside prescription ranged from 9.7% to 16.4%, over 5 years. Reasons for prescribing three antimicrobials, use of aminoglycosides, or higher-end/reserve antibiotics were not mentioned in the medical records. There were no hospital-specific guidelines for doctors to follow in the treatment of CAP.Conclusions:These findings suggest the need for implementing antimicrobial treatment guidelines. Adequate documentation and monitoring of antibiotic use for feedback are also lacking. An antimicrobial stewardship program may offer the most comprehensive solution for appropriate use of antimicrobials.

Need to improve availability of “access” group antibiotics and reduce the use of “watch” group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance

“…Penicillins are recommended as the first line antibiotics for treatment of respiratory tract infections [12]. However, recent trends indicate that penicillins are increasingly substituted by second and third generation cephalosporins for treatment of respiratory tract infections in both outpatient [13, 14] and inpatient settings [15, 16]. In a study between December 2007 and November 2008 which conducted exit interviews of patients with upper respiratory tract infections showed that in private clinics, cephalosporins were prescribed to 39% of patients followed by fluoroquinolone (24%), penicillins (19%) and macrolides (11%) [13].…”

Identification of Genes Coding Aminoglycoside Modifying Enzymes inE. coliof UTI Patients in India

“…With the passage of time, the burden of bacterial infections is showing an ascending trend and this is largely due to the generation of resistance mechanisms by bacteria [ 2 , 3 ]. Among the various patterns of resistance, reports across the globe continue to emerge on the resistance to aminoglycoside antibiotics which otherwise have been reported as highly potent drugs against life threatening Gram-negative bacterial infections [ 4 , 5 ]. Aminoglycosides act primarily by impairing bacterial protein synthesis through binding to prokaryotic ribosomes via 16S ribosomal RNA (16S rRNA) and by disrupting the bacterial cell membrane integrity [ 6 ].…”

Empiric antibiotic therapy in the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia

“…[20] In an Australian study, ceftriaxone and azithromycin combination was used for 56% of the patients[21] and one-third of patients with CAP in an Indian study received macrolide and a beta-lactam. [22]…”