Patterns of antibiotic prescriptions and appropriateness in the emergency room in a major secondary care hospital in Bahrain

Abstract

Objective: To describe the pattern and appropriateness of antibiotics prescribed in the emergency room in a major secondary care hospital in Bahrain. Methods:Patients aged more than or equal to 14 years old that attended emergency room and was prescribed antibiotics from 1 to 31 July 2014 were included. Data were obtained from patients' emergency records. Antibiotic treatment was classified to appropriate, inappropriate or unjustified use according to the local or international guidelines. Chi Square was performed to evaluate the variables associated to appropriateness antibiotic treatment.Results: A total of 1313 patients were included (52.6% males), mostly in the age group 14-30 years old (45.3%). The most frequent diseases attended were upper respiratory and urinary tract infections (27.3% and 22.1%,respectively). Cefuroxime was the most prescribed antibiotic (37.5%) followed by ciprofloxacin (20.8%). Percentage of inappropriate antibiotics prescription was 81.9% mostly due to unjustified use. Inappropriate antibiotic treatment was significantly more common in males (87.1%; P-value <0.001), in patients without mentioned diagnosis, then upper respiratory tract infection (100%, 96.9%. P-value <0.001) and prescriptions written by emergency physicians (85.5%; P-value <0.001).

Professional practice evaluation of emergency department prescriptions for community-acquired infections in Lebanon

“…Previous studies performed in developing countries have noted appropriate prescription of antibiotics in less than 20% of clinical cases (Al-Niemat et al, 2014;WHO, 2001). According to a study conducted in Bahrain in 2015 (Al Salman et al, 2015), the rate of inappropriate antibiotic use was 80.9%, much higher than the rate reported in the present study and in other countries such as Australia (48.6%) (Cotta et al, 2014), Denmark (47%) (Hagen et al, 2017), and Spain (43%) (Ramos Martnez et al, 2005). However, in a study conducted at Mohammad V Hospital in Meknas, Morocco (Elbouti et al, 2016), 70.5% of prescriptions were both relevant and compliant.…”

“…The b-lactam antibiotics were the most commonly prescribed incompatible drugs (70.7%). The implementation of international guidelines for the treatment of various infectious diseases, such as CAP, UTI, and other infections in hospital settings (Dellinger et al, 2013;Stevens et al, 2014;Mandell et al, 2007;Nicolle et al, 2005;Coplen, 2011;Hooton et al, 2010), has been demonstrated to be an effective tool in improving antibiotic utilization and therefore reducing the development of resistant organisms (Al Salman et al, 2015;Cotta et al, 2014). The incompatibility observed in the present study shows the importance of the proper implementation of international guidelines in the Lebanese context, and further studies should evaluate the effect of guideline implementation on patterns of antibiotic resistance.…”

“…In this study, the b-lactam group of antibiotics was most commonly prescribed (with carbapenems the most prescribed of these), followed by fluoroquinolones. Similarly, in the study performed in Bahrain (Al Salman et al, 2015), b-lactams were the most utilized antibiotics. In contrast to the present study, cephalosporins, specifically cefuroxime (37.5%), were the most prescribed antibiotics (Al Salman et al, 2015).…”

“…Similarly, in the study performed in Bahrain (Al Salman et al, 2015), b-lactams were the most utilized antibiotics. In contrast to the present study, cephalosporins, specifically cefuroxime (37.5%), were the most prescribed antibiotics (Al Salman et al, 2015). Similarly, in the Moroccan study (Elbouti et al, 2016), cephalosporins followed by fluoroquinolones were the most often prescribed.…”

Study of antimicrobial prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students

“…This was similar to earlier studies where most of the patients in whom antimicrobials were prescribed belonged to 16-30 years of age group. 12,13 Majority of the patients were suffering from respiratory tract infections in our study. This was similar as previous studies indicating that respiratory tract infections dominate amongst all infections.…”