Pattern of Drug Utilisation in Neonatal Intensive Care Unit in a Tertiary Care Hospital
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Cited by 6 publications
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Summary What is known and objectives When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A‐PINCH (Anti‐infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high‐risk medicines list, and determining whether there are any differences in medicine use between countries. Method Quasi‐systematic literature review. Search strategy Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. Results A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A‐PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off‐label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. What is new and conclusion Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off‐label and unlicensed medicines.
Summary What is known and objectives When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A‐PINCH (Anti‐infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high‐risk medicines list, and determining whether there are any differences in medicine use between countries. Method Quasi‐systematic literature review. Search strategy Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. Results A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A‐PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off‐label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. What is new and conclusion Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off‐label and unlicensed medicines.
Retracted: Drug Utilization Pattern of Antibiotics in Neonatal intensive care unit in a Tertiary Care Hospital, India
Millions of babies are admitted to neonatal intensive care units worldwide, with a significant proportion facing various indications. Given that sepsis is a leading cause of mortality and morbidity among infants globally, including in India, the importance of efficient antibiotic use cannot be overstated. As the global problem of drug resistance intensifies, prudent antibiotic usage becomes crucial in mitigating treatment failures and ensuring the survival of newborns. Aim: to evaluate the pattern of antimicrobial drug utilization in neonatal intensive care unit (NICU) to assess the criteria for drug selection in tertiary care hospital.Materials and Methods. It was an observational prospective study conducted for six months in which 200 neonates admitted to neonatal intensive care unit at tertiary care Hospital, were included. Demographic details, duration of hospital stay, reason for admission (disease pattern), various drugs prescribed were noted. Results. Out of 200 neonates the number of male babies admitted to neonatal intensive care unit were 115 (57.5%) and female babies were 85 (42.5%). Many of the neonates were from age group of 1 to 5 (58.5%) days. Most of the neonates were from weight group of 2.5 to 3 (26.5%) kg. Majority of neonates hospital admission duration was 3 to 6 days is 98 (49%) neonates. Most common disorder requiring neonatal intensive care unit admission was Preterm with Respiratory Distress Syndrome (29%) followed by Neonatal Sepsis (19.5%) and Preterm (11%). Other distress reported include birth asphyxia (16 neonates or 8%), Neonatal convulsions (12 neonates or 6%), Late preterm (13 neonates or 6.5%), Hypernatremia (9 neonates or 4.5%), Meconium Aspiration Syndrome (3 neonates or 1.5%), Neonatal Hypoglycemia (5 neonates or 2.5%) and others (23 neonates or 11.5%). Among 423 antibiotics most prescribed antibiotic was Inj. Piperacillin + Tazobactam (35.4%) followed by Gentamycin (30.2%). Out of 423 drugs 152 are fixed dose combination and single drugs are 271 in this study in which piperacillin + tazobactam of fixed dose combination and gentamicin dose combination and single drugs are 271 in this study in which piperacillin + tazobactam of fixed dose combination and gentamicin of single drug had prescribed in more amount.Conclusion. The findings of this study will contribute to the existing body of knowledge regarding the appropriate use of antibiotics in the NICU, thereby providing insights for healthcare professionals to make informed decisions regarding antibiotic therapy. Empirical antibiotics were administered to every newborn based on their individual conditions. The antibiotic utilization pattern within this study group was determined to be rational.
Objectives: The present study was taken up to evaluate the drug utilization pattern and adverse drug reactions (ADRs) seen in patients of neonatal sepsis admitted to sick newborn care unit of a tertiary care hospital in Uttarakhand. Methods: This was a prospective observational study. A suitable case record form was designed to collect all the necessary and relevant information. Data of 175 neonatal sepsis matching inclusion criteria were recorded. Pattern of prescription of drug for various diseases in sick newborns was analyzed. Information on ADR were analyzed. ADR was analyzed using Naranjo scale and the WHO causality assessment scale. Results: Blood culture was positive in 137 (78.29%) neonates. Staphylococcus aureus (45.26%) was the most common microorganism followed by Klebsiella pneumoniae (26.28%) and Escherichia coli (14.60%). Out of 137 blood culture-positive neonates, 30.66% were suffering from meningitis. Out of 38 blood culture-negative neonates, 63.16% were suffering from meningitis. Average number of drugs per encounter was 1.71. Percentage of drugs prescribed by generic name was 91%. Parenteral route was the most common route of drug administration. Ampicillin was the most common antimicrobial prescribed. Next common classes of drug used were vasopressor. Out of 10 (5.71%) ADRs identified, 70% were possible and 30% were doubtful as per Naranjo’s causality assessment scale. Case fatality rate was 27.42% during the course of study. Conclusion: Parenteral antibiotics (ampicillin plus gentamycin) and vasopressors remain the most commonly prescribed drugs in neonatal sepsis in sick newborn unit. The study concluded that doses and duration, for which drugs were used, were in accordance to AIIMS protocol for neonatal sepsis.
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