A Study on Prescribing Pattern, Indications and Rationality of Restricted Antibiotic Use in a Tertiary Care Hospital

Abstract

Background: Antibiotic stewardship aims to optimise restricted antibiotic use and thereby prevent the emergence of antibiotic resistance and improve treatment outcome. Resistance to conventional antimicrobial’s is a major reason why restricted antibiotics are prescribed. Aim: To assess the prescribing pattern of restricted antibiotics, the indications for which restricted antibiotics were prescribed, the drug related problems associated and the sensitivity pattern of the isolated organisms. Results: Out of 340 patients included in the study, majority of patients was in the age group of 58-67(60.06 ±14.90) in both genders. There was a male (64.12%) dominance observed in the study populace and the minimum and maximum age observed was 18 and 93 years respectively. Most commonly prescribed antibiotic was Piperacillin tazobactum (31%) followed by Linezolid (16.06%). Empirically the most prescribed antibiotic was Piperacillin tazobactum (27.37%) while in definitive therapy it was Cefepime tazobactum (10.63%). The most common indication for which restricted antibiotics prescribed were for respiratory tract infection (n=116), followed by infection prophylaxis (n=114). Mean days of restricted antibiotic therapy was found to be 8.85 days ± 8.11. The maximum duration of antibiotic treatment was 62 days and minimum was 1 day. In 47% of cases IV to oral conversion was possible. When analysed retrospectively, in majority of the patients the duration of restricted antibiotic treatment was inappropriate (69.71%) while the inappropriateness in frequency and dose were 7.05% and 3.23% respectively. The total number of cultures collected were 292 in that 120 cultures were urine and found growth in 50.83%, followed by 84 cultures in sputum which accounted for 67.85% growth. The most common organism isolated was Klebsiella pneumoniae 39.73% cases followed by Pseudomonas aeruginosa 17.46% and Acinetobacter baumannii15.41. There was clinical cure in 91.47% of cases. Conclusion: When analysed retrospectively majority of the restricted antibiotics showed inappropriateness. This higher amount of inappropriateness could have been avoided to a certain extent, by the timely interventions of a clinical pharmacist. By implementing an effective antimicrobial stewardship program we could improve the rational use of restricted antibiotics and thereby prevent the future resistance and improve clinical outcome.