Drug prescribing pattern and clinical outcome in intensive care unit of a Dedicated COVID Hospital: A retrospective observational study

Ismail, Teli Shaikh Emaran Shaikh; Bhangale, Chetan; Mahajan, Harshal M.; Gaikwad, Vijay

doi:10.5455/njppp.2022.12.09345202126092021

Cited by 3 publications

(9 citation statements)

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“…13 Despite the aforementioned shortage, the adherence to tocilizumab seen in this study is higher than the prescription patterns reported in other COVID-19 centers across the world (0.5 to 40%). 9,[14][15][16] Overuse of empiric antibiotics is associated with disease severity (i.e., more severe cases are given antibiotics without sufficient indication) and location of treatment (i.e., ICU patients are given antibiotics without sufficient indication). A similar trend was observed in the use of azithromycin where highest adherence rates were seen in mild cases and the lowest adherence seen in critical cases.…”

Section: Discussionmentioning

confidence: 99%

Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public Hospitals in Metro Manila, Philippines: A Rapid Assessment Study

2022

Acta Med Philipp

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Objectives. Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19.Methods. This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed.Results. A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given. Conclusion.Management of COVID-19 in both centers was generally adherent to guideline recommendations. We detected high underuse of tocilizumab probably related to the global supply shortage during the study period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies.

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Section: Discussionmentioning

confidence: 99%

Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public Hospitals in Metro Manila, Philippines: A Rapid Assessment Study

2022

Acta Med Philipp

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“…Ismail et al reported that the sufferings level of the majority COVID‐19 infected patients was mild to moderate, while the maximum may recover with or without specialized treatment 5 . However, in the European region, geriatric population or concomitant diseases like diabetes, cardiovascular disease, chronic respiratory diseases, and cancer increase the COVID‐19 complications that ultimately leads to intensive care unit (ICU) admission as well as life‐threatening consequences 5–7 .…”

Section: Introductionmentioning

confidence: 99%

“…But overprescribing of antibiotics may complicate the condition more due to the drastic development of antimicrobial resistance (AMR) which is becoming a silent threat to human existence globally. Already WHO has shown concern about the possibility of a destructive AMR situation due to irrational antimicrobial uses during a pandemic 5 . Not only antibiotics but also many other drugs are also indiscriminately used for the treatment of COVID‐19 patients which can be seen in several studies 5 …”

Section: Introductionmentioning

confidence: 99%

“…Already WHO has shown concern about the possibility of a destructive AMR situation due to irrational antimicrobial uses during a pandemic 5 . Not only antibiotics but also many other drugs are also indiscriminately used for the treatment of COVID‐19 patients which can be seen in several studies 5 …”

Section: Introductionmentioning

confidence: 99%

“…4 Ismail et al reported that the sufferings level of the majority COVID-19 infected patients was mild to moderate, while the maximum may recover with or without specialized treatment. 5 However, in the European region, geriatric population or concomitant diseases like diabetes, cardiovascular disease, chronic respiratory diseases, and cancer increase the COVID-19 complications that ultimately leads to intensive care unit (ICU) admission as well as lifethreatening consequences. [5][6][7] This catastrophic situation caused various clinical complications that required special care, including medical care, psychological care, respiratory support, life support, and renal replacement therapy, leading to admission to the ICU.…”

Section: Introductionmentioning

confidence: 99%

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Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Rahman,

Islam,

Paul

et al. 2023

Health Science Reports

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Background and AimsTo reduce death rates for critical patients hospitalized in intensive care units (ICUs), coronavirus (COVID‐19) lacks proven and efficient treatment methods. This cross‐sectional study aims to evaluate how physicians treat severe and suspected COVID‐19 patients in the ICU department in the absence of an established approach, as well as assess the rational use of the medication in the ICU department.MethodsBetween June 16, 2021, and December 10, 2022, a total of 428 prescriptions were randomly gathered, including both suspected (yellow zone) and confirmed (red zone) COVID‐19 patients. For data management, Microsoft Excel 2021 was utilized, while STATA 17 provided statistical analysis. To find associations between patients' admission status and demographic details, exploratory and bivariate analyses were conducted.ResultsOf the 428 patients admitted to the ICU, 228 (53.27%) were in the yellow zone and 200 (46.73%) were in the verified COVID‐19 red zone. The majority of patients were male (54.44%), and the age range from 41 to 60 was the most common (41.82%). No significant deviation was detected to the yellow and red groups' prescription patterns. A total of 4001 medicines (mean 9.35/patient) were prescribed. Antiulcerants, antibiotics, respiratory, analgesics, anticoagulants, vitamins and minerals, steroids, cardiovascular, antidiabetic drugs, antivirals, antihistamines, muscle relaxants, and antifungal treatments were widely prescribed drugs. Enoxaparin (67.06%) appeared as the most prescribed medicine, followed by montelukast (60.51%), paracetamol (58.41%), and dexamethasone (51.64%).ConclusionThe prescription patterns for the yellow and red groups were comparable and mostly included symptomatic treatment. Respiratory drugs constituted the most frequent therapeutic class. Polypharmacy should be taken under considerations. In ICU settings, the outcomes emphasize the need of correct diagnosis, cautious antibiotic usage, suitable therapy, and attentive monitoring.

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Effect of remdesivir on mortality rate, need of intubation and mechanical ventilation in COVID-19 positive patients: a retrospective observational study

et al. 2023

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Background: The symptoms of SARS-CoV-2 infection vary widely, from asymptomatic disease to pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and ultimately, death. Remdesivir has broad spectrum of activity against members of several virus families, including filoviruses and coronaviruses. Remdesivir is a potent inhibitor of SARS-CoV-2 replication in human nasal and bronchial cells. Methods: This is a prospective and observational study conducted in patients of either gender, age more than 18 years with confirmed diagnosis of COVID-19 by RT-PCR. A predesigned, pretested and semi structured questionnaire containing socio demographic details like age, sex, BMI, comorbidities, findings of systemic examination of the cases, dose and duration of Remdesivir received and adverse effect due to therapy was used to collect the data. Results: Mean age of the patients were 56.19±10.93 years. Male patients were 66% and 34% patients were female. After receiving the remdesivir, 43% of the patients needed bag mask and 27% of the patients maintained on room air oxygen. Non-invasive ventilation required in 19% of the patients and 11% of the patient required mechanical ventilation. s14% of the patients needed admission in the ICU. 3.5% of the patients were died and 96.5% patients were discharged from the hospital. Conclusions: Remdesivir reduces the need of non-invasive oxygenation and mechanical ventilation. Mortality was seen in 3.5% patients, henceforth remdesivir, is an effective drug for moderate to severe COVID-19, if given in early stages of infection.

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Drug prescribing pattern and clinical outcome in intensive care unit of a Dedicated COVID Hospital: A retrospective observational study

Cited by 3 publications

References 0 publications

Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public Hospitals in Metro Manila, Philippines: A Rapid Assessment Study

Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public Hospitals in Metro Manila, Philippines: A Rapid Assessment Study

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Effect of remdesivir on mortality rate, need of intubation and mechanical ventilation in COVID-19 positive patients: a retrospective observational study

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