An Antibacterial Drug Utilization Study at Surgical Units of Shree Sayaji General Hospital, Vadodara, Gujarat, India

Abstract

IntroductionAntibacterials account for nearly 20% of all new and repeat prescriptions each year and over 50% of total value of drugs sold in India. Irrational prescribing of these drugs is known to take place throughout the world. In developing countries like India, this may be extremely important as the funds available for healthcare budget may be quite limited. It has been observed that 64% of the total antibacterials prescribed are either not indicated or inappropriate in terms of drug selection or dosage or therapeutic basis. It is clear that if this can be improved, then misuse of antibacterial can be avoided to a large extent. However before suggesting any change, it is necessary to evaluate the existing base line practice which can be done using data on prescriptions and prescribing practices with the help of a drug utilization study. This may therefore, help us to identify the problems, suggest the remedial measures and promote rational use. So, to analyze the same at Shree Sayaji General Hospital (SSG Hospital), a tertiary level teaching hospital, Vadodara, Gujarat in six surgical units this study was carried out. AimPrimary aim of the study was to evaluate the extent and pattern of use of antibacterial agents, in in-patients of six surgical units of SSG Hospital, Vadodara with secondary aim to determine the type of antibacterial used along with their purpose of use, route of administration, duration and supply.Material and MethodsThis was a prospective study with duration of 6 months from March, 2006 to August, 2006. Six units of general surgery with one ward for each of them were selected for the work. Fifty patients admitted to each unit during the time of the study were randomly selected for the work making total number of 300 cases. Patients had been visited thrice weekly for recording all the relevant details of the case (s) in a pre-validated, predefined performa for a consequent analysis. The performa included diagnosis, date of admission, operation (if any) and discharge. Along with these, drug utilization details that included trade name of the drug(s), dose, route and frequency of administration, duration of treatment, indications (whether prophylactic or curative), source (hospital supply / market purchase) were also collected. Results of the culture and sensitivity tests if performed along with any other laboratory tests were also recorded. Adverse drug reactions were also monitored. The data obtained was analyzed for important prescribing indicators i.e. common surgical conditions observed amongst indoor patients in general surgery department, groups of antimicrobial agents used commonly, Individual antimicrobial agents used commonly, number of patients where antibacterial drugs were given orally or parenterally, purpose for the antibacterial drug use (prophylactic/curative) etc. ResultsAmong 300 indoor patients, there were 228 males (76%) as compared to 72 females (24%). It was observed that antimicrobial drugs were prescribed in all 300 indoor patients in surgery. Showing selection of antibiotics for the indoor patients of six surgical units of SSG Hospital, Vadodara, Gujarat. Although no significant difference was observed in the antimicrobials prescribed by oral and parenteral route, yet out of the 1051 drugs prescribed, more no. of antimicrobials were given through oral route 53% (552) than through parenteral route 47%(499). In596(54%) out of 1051(100%) prescriptions, the use of antimicrobial agents was indicated for prophylaxis while remaining 482(46%) out of 1051 prescriptions the intention appeared to be curative for an existing or hospital acquired infections. Out of 300 patients culture and sensitivity test was done only in 3.1% of cases only. Out of 1051 total prescriptions, 86.6% (911) drug were supplied from government setup as compared to of 13.3% (140) drugs, which the patients were directed to buy from the market.Conclusion The pooled data of all the patients show that antibacterial agents are widely used in the admitted patients in all surgical units irrespective of whether an operative procedure was carried out or not. Newer cephalosporins like cefotaxime have replaced penicillin in most of the conditions, along with metronidazole & gentamicin as broad spectrum cover. Multiple antibacterial drug use is very common. Irrational and inappropriate use of antibacterial agents for surgical prophylaxis has been observed in this study. This includes inappropriate choice of drug and duration of use in most of cases. Inadequate and almost minimal use of microbiological support while prescribing antibacterial agents has been observed. These results indicate a considerable scope for improving the prescribing pattern of drugs and minimizing the use of antibacterial agents in all surgical specialties. An Antibacterial Drug Utilization Study at Surgical Units of Shree Sayaji General Hospital, Vadodara, Gujarat, India