Abstract
BackgroundThe inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan.MethodsLongitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary.ResultsA total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%).ConclusionEducational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.
Highlights
The inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality
Whilst antibiotics are principally prescribed in ambulatory care [3], antibiotics are still frequently prescribed in hospitals
The diagnosis was based on clinical judgement as typically culture and sensitivity testing (CST) is not undertaken in hospitals in Pakistan unless patients are in a critical condition in view of financial constraints
Summary
The inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Inappropriate antibiotic use poses a major challenge to public health in terms of increasing antimicrobial resistance (AMR) with its associated impact on morbidity, mortality, and costs as well as increasing adverse effects [1]. This has resulted in a number of activities globally, regionally, and nationally to reduce rising rates of AMR [2]. There are concerns about the extent of inappropriate prescribing of antibiotics in hospitals [8]. In Romania, Saleem et al Antimicrobial Resistance and Infection Control (2019) 8:188
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