Abstract
Background and objectives: The clinical value of a microbiology report has always been queried. There are various factors that influence a prescription in the treatment of patient after admission to the hospital. This study was undertaken to study factors that guide prescription practice after the availability of antibiotic sensitivity report and to study the pattern of choice of empirical therapy among patients admitted with various infections. Methods: This is a hospital based cross sectional study done in a tertiary care hospital. 139 patients were included in the study. The reasons influencing the physician to continue the empirical therapy even after the availability of AST reports were collected using a proforma. Results: A total of 139 patients were analysed in this study. Among 139 patients, 122 (87%) patients were started on empirical therapy. A follow up could be made only for 59 (48%) patients, the rest were either discharged or referred before a follow up was made. Among 59 patients, 30 (50%) patients were continuing empirical therapy even after the availability of AST reports, for 21(36%) patients antibiotic was changed as per AST report. With a predesigned proforma, various opinions of the physicians were obtained and the major reason for continuation of empirical therapy was patients condition improving with the existing drug and a change of antibiotic was not necessary. Interpretation and conclusions: Analysis of the data showed that majority of the physicians were continuing empirical therapy even after availability of AST reports as they felt patient improved with empirical therapy or the drug that is effective as per AST report is expensive. The study also revealed that third generation cephalosporins is more commonly used as an empirical choice of treatment.
Highlights
Antibiotic sensitivity test (AST) reports in many hospitals have not significantly influenced physicians’ choice of antibiotic therapy
After AST reports become available, treatment should be changed to narrow spectrum antibiotic which has specific target of action to minimise the emergence of resistance[2]
If the patient was receiving the same empirical antibiotic even after receiving the AST report, an attempt was made to know from the physicians with a predesigned proforma why empirical therapy was continued. 2.2 Survey instrument: A predesigned Proforma was used to record AST report along with other details which was traced to the concerned patient’s case sheet and treating physician. 2.3 Data analysis: Data was analyzed using Microsoft Excel 2010 version and qualitative outcomes are summarized using count and percentages and quantitative outcomes are summarized using mean, median, and mode. 2.4 Ethical considerations: Institution ethics committee approval was obtained before starting the study
Summary
Antibiotic sensitivity test (AST) reports in many hospitals have not significantly influenced physicians’ choice of antibiotic therapy. After AST reports become available, treatment should be changed to narrow spectrum antibiotic which has specific target of action to minimise the emergence of resistance[2]. A study done by David Tompkins[3] about microbiology antibiotic sensitivity reports through questionnaire to physicians revealed that 34% of reports gave unexpected findings, 28% resulted in a change of therapy and most of the investigations (83%) were seen as beneficial to the patients. In another study conducted by Samir K Saha4, 27% of the cases, a change in management to an agent active for treatment of the isolate was made after receipt of the test results. An attempt was made to know the choice of empirical therapy for different infections
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