Surveillance and pharmacoeconomics of antimicrobial use among inpatients in a tertiary care, teaching hospital in New Delhi, India: Assessing need for policy formulation

Abstract

Objective: Although extensive use of antimicrobial medicines (AMMs) has been reported in India, there are limited data on AMM use and expenditure incurred on the same among inpatients. This study was conducted to determine (i) the pattern of AMM prescribed, (ii) adherence of AMM used with the hospital essential medicine list (EML), and (iii) expenditure incurred on AMM. Materials and Methods: An observational, prospective study was conducted among inpatients in Medicine and Surgery Departments of a tertiary care teaching hospital in New Delhi, India, who were receiving AMM. AMM use characteristics (name, dose, dosage form, frequency, duration, route) and expenditure incurred and ABC analysis was done. Results: AMMs were prescribed to 60.1% of patients. Of these, the indication for prescribing AMM was therapeutic in 76.1% patients. On an average, 2.52 antimicrobials were prescribed per patient. The most common route of antimicrobial administration was parenteral (71.9%). Biological samples were sent for bacterial culture sensitivity testing only in 21.1% cases, of which 23.6% were positive. A total of 46 different antimicrobials were prescribed. The most commonly prescribed AMMs were ceftriaxone, metronidazole, ciprofloxacin, amoxicillin-clavulanic acid, and levofloxacin. The number of AMMs prescribed from EML was 1125 (74.4%). Expenditure on antimicrobials accounted for 52% of the total expenditure on medicines. ABC analysis revealed that the maximum expenditure (72%) was on medicines used in a small (9.82%) percentage of patients. The parenteral use of newer, more expensive antimicrobials, not included in the hospital EML, accounted for a large proportion of expenditure on antimicrobials. Conclusion: There is an urgent need to develop a hospital antimicrobial policy, guidelines for use, and generate awareness among physicians to improve and rationalize the economy of antimicrobial use in the hospital.