A clinical study on quality use of antimicrobials and self-medication, medication adherence of antimicrobials in community and hospital settings

Abstract

Background: Antimicrobial resistance is a global health concern. Globally, between 20 to 50% of antimicrobial consumption is inappropriate, causing significant impact on the quality of care, cost of therapy and incidence of adverse drug reactions and posing a huge risk of antimicrobial resistance. Aim and objectives: Research study aims to assess extent of quality use of antimicrobials among inpatients & outpatients by using inpatient quality indicators, outpatient quality indicators, assessing of self-medication of antimicrobials in community and general public, medication adherence to antimicrobial therapy in outpatients. Methods and materials: Prospective, interventional study. Inpatient and Outpatient quality indicator were used to assess Quality use of antimicrobials. Document review of Prescriptions, Review of patient records, Overview of drug consumption in hospitals and distribution, Semi-structured interviews, Focus group discussions used for data collection. Results: Inpatients: Empirical systemic antibiotic therapy prescribed according to the local guideline has improved from 58.39% to 7.95% as a result of intervention (Imposing of physicians and clinical pharmacist to strictly adhere to local guidelines which are prepared and made available). Practice of ordering at least 2 sets of blood cultures before starting systemic antibiotic therapy also improved from 33.18% to 48.96%, which profoundly impacted the appropriate antimicrobial selection. Empirical antibiotics should be changed to pathogen-directed therapy after culture results become available was also improved from 41.38% to 54.89% after intervention of using of antibiotic usage policy. Outpatients: Antibiotic prescribing in viral infections or (most) self-limiting bacterial infections was made to limit from 43.27% to 38.21% by intervention of prescription auditing, medication review by clinical pharmacist. Prescribed antibiotics should be chosen from an essential list/formulary also improved from 67.12% to 79.14% due to the intervention of designing and dissemination of Essential antimicrobial list and Hospital formulary for individual health care facilities. Conclusion: Research study concludes that, in inpatients, outpatient's majority of antimicrobials are being used Non adherently to quality use indicators so there is a huge need of Promotion of rational use of antimicrobials by raising awareness on antimicrobial resistance and join hands of all health care professionals for combating antibiotic resistance with local solutions to tackle global challenge.