Antibiotic Restriction Research Articles

Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis

ObjectiveSeveral control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing...

Impact of requiring re-authorization of restricted antibiotics on day 3 of therapy.

Pre-authorization of restricted antibiotics is a core component of an antibiotic stewardship programme (ASP). On day 3, information about culture results and clinical status is typically available. Our objective was to compare an ASP that requires initial authorization alone with one requiring initial authorization and re-authorization on day 3 of therapy. A single-centre, retrospective, before and after study was conducted. Randomly selected adults were eligible if receiving a restricted antibiotic for ≥3 days during April to June in 2012 (pre-intervention) and during the same months in 2013 (post-intervention). The target sample size was 166 patients. The intervention required re-authorization of restricted antibiotics that were continuing on day 3. The days of therapy of restricted antibiotic(s), length of hospital stay (LOS) and hospital mortality were compared between pre- and post-intervention periods. The ASP intervention was associated with a decrease in median days of therapy from 5 (4-9) to 4 (3-5) days (P < 0.001) for all restricted agents, from 5 (3-6) to 3 (3-5) days for broad-spectrum Gram-negative agents (P < 0.001) and from 6.5 (6-7) to 3 (3-4.5) days for oral vancomycin. The proportion of subjects receiving restricted agents for >4 days decreased from 57.8% to 30.1% (P < 0.001). LOS decreased from 8 (5-17) to 6 (5-9) days (P = 0.005) without a significant change in hospital mortality. Requiring re-authorization of restricted antibiotics on day 3 of therapy in addition to initial authorization was associated with reduction in overall consumption of restricted antibiotics and LOS without adversely affecting hospital mortality.

Description of a restriction program for gram-positive antimicrobial agents at an academic medical center

This report examines the effectiveness of antimicrobial restriction at 1 tertiary care health care system by analyzing the consumption of restricted versus nonrestricted gram-positive agents over time for medical versus surgical units. Significant reductions in restricted antibiotic use were detected in 57% of medical units versus none of the surgical units. There were no significant reductions in nonrestricted antibiotic use. We think looking at antibiotic consumption by service line provides opportunities for targeted antibiotic restriction program refinement.

Emergence of armA and rmtB genes among VIM, NDM, and IMP metallo-β-lactamase-producing multidrug-resistant Gram-negative pathogens.

In the recent years, it has been noted that microorganisms with acquired resistance to almost all available potent antibiotics are increasing worldwide. Hence, the use of antibiotics in every clinical setup has to be organized to avoid irrational use of antibiotics. This study was aimed to establish the pattern of antibiotic sensitivity and relevance of antimicrobial resistance in aerobic Gram-negative bacilli. A total of 103 aerobic Gram-negative bacteria namely Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Citrobacter koserii, Proteus spp., and Pseudomonas aeruginosa were collected from tertiary care centers around Chennai. Kirby-Bauer Disk Diffusion test and study for genes of cephalosporin, carbapenem, and aminoglycoside resistance were done. A descriptive analysis of the data on altogether 103 clinical urine isolates was performed. All strains showed susceptibility to colistin. The frequency of genes encoding 16S rRNA methylases armA and rmtB were 7.8% and 6.8%, respectively. Among metallo-β-lactamases, blaVIM, blaIMP, and blaNDM-1 were detected in 6.8%, 3.8%, and 3.8%, respectively. One E. coli strain harbored blaSIM-1 gene. Cumulative analysis of data suggested that 30% of the strains carried more than one resistance gene. The current research evidenced the increasing frequency of resistance mechanisms in India. Combined approach of antibiotic restriction, effective surveillance, and good infection control practices are essential to overcome antibiotic resistance.

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

BackgroundThe Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry.MethodsWe performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015ResultsAll hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting.ConclusionsFive out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.

Bacteriological analysis including antimicrobial susceptibility pattern of blood stream infections in tertiary care hospital

Background: Blood stream infections cause significant morbidity and mortality worldwide. Illness associated with blood stream infection ranges from self-limiting infections to life- threatening sepsis that require rapid and aggressive antimicrobial treatment. Rational and correct use of antibiotic requires understanding of common pathogens and their drug resistance pattern in the community as well as hospital.Methods: A retrospective study was conducted on the microbial profile of isolates of blood culture and their antimicrobial sensitivity pattern in a tertiary care hospital. Blood culture samples received from January to December 2015 in Microbiology department of the laboratory were enrolled in the study.Result: Positivity of the blood culture was found to be 16.66% (312/1872). Among the isolates, Gram negative organisms were 66.76% (203/300) while gram positive organisms were 32.33% (97/300) including 45 (15%) fungal isolates which were of various candida species. Klebsiella species was the most commonly isolated organism (27.3%) followed by E.coli (18.6%) and Acinetobacter species (8.3%). Staphylococcus aureus was isolated in 6% cases. Colisitin was found to be showing 100% sensitivity for Klebsiella, E.coli, Acinetobacter and Pseudomonas. Vancomycin was found to be sensitive for all Staphylococci isolated from blood. Ampicillin failed to show significant sensitivity against any of the above mentioned organisms.Conclusion: Specific antibiotic usage strategies to be prepared and implemented in the form of antibiotic usage policy like antibiotic restriction, combination therapy and usage according to the standard antibiotic susceptibility testing are needed for each tertiary care hospital to prevent emergence and spread of drug resistance. DOI: 10.21276/APALM.1203

Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation.

Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions). From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, .09-.29), after adjusting for indication, Charlson comorbidity index, and care setting. An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.

Evaluation of antibiotic prescribing for adult inpatients at Sultan Qaboos University Hospital, Sultanate of Oman

ObjectiveLittle is known into the prudent use of antibiotics in hospitals in Oman. This study is to evaluate antibiotic prescribing by measuring the overall compliance with the local antibiotic prescribing...

Study of the prevalence of micro organisms and impact of usage of restricted antibiotics in a tertiary care hospital

Study of the prevalence of micro organisms and impact of usage of restricted antibiotics in a tertiary care hospital

Study of the prevalence of micro organisms and impact of usage of restricted antibiotics in a tertiary care hospital

Study of the prevalence of micro organisms and impact of usage of restricted antibiotics in a tertiary care hospital

Evaluación del uso de antibióticos e impacto de una intervención dirigida a modificar la conducta prescriptiva en profilaxis quirúrgica en 6 hospitales del área metropolitana de Monterrey

BackgroundImproper use of antibiotics increases antimicrobial resistance. ObjectiveEvaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. Material and methodsDesign: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. Analysis: Frequencies, percentages, medians, ranges and X2 test. ResultsPhase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). ConclusionsInappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Antibiotic Prescribing and Stewardship Opportunities within a Veterans Affairs Dental Care Practice

BackgroundAntibiotic overuse is a major healthcare problem worldwide. Dental providers prescribe approximately 10% of outpatient antibiotics nationally. As a part of a larger quality improvement initiative, the prescribing habits of the Veterans Affairs Pittsburgh Dental Providers were reviewed.MethodsOutpatient antibiotic prescriptions by dental providers at the Veterans Affairs Pittsburgh Dental Clinic from June 2015 - May 2016 were identified. A random sample of all prescriptions were reviewed for antibiotic prescribed, type of visit during which the prescription occurred, procedure associated with prescription, and indication. Available American Dental Association (ADA) guidelines were used to define appropriateness.ResultsOver the period reviewed, 15111 total outpatient prescriptions were filled at VA Pittsburgh, of which 1505 (10%) were prescribed by 21 dental providers. Antibiotics most commonly prescribed by dentists were amoxicillin (78%), clindamycin (13%), penicillin VK (4%), and amoxicillin/clavulanate (3%). Antibiotic prescriptions ranged from 1–15 days with an average of 5 days. 182/1505 (12%) of antibiotic prescriptions were randomly selected for chart review. Seventy-eight percent (142/182) visits were labeled as routine, and 22% (40/182) were acute. The most common procedures performed at visits where antibiotics were prescribed were exams 24 % (43/182), extractions 42% (77/182) and cleanings 9% (17/182). The most common reasons for antibiotic prescriptions were post-operative complications 52% (96/182), prophylaxis 19% (34/182) and abscess 13% (23/182). Seventy-four percent (135/182) of antibiotic prescriptions were concordant with existing ADA guidelines. Of non-concordant prescriptions, 43% (21/48) were written for antibiotic prophylaxis.ConclusionDental providers are active prescribers of outpatient antibiotics, and current dental guidelines are weak in antibiotic restriction. Opportunities for prescribing improvement exist, in particular with prophylaxis. Dental providers represent a potentially overlooked target for antimicrobial stewardship intervention.Disclosures All authors: No reported disclosures.

Restricted Parenteral Antibiotics Usage Policy in a Tertiary Care Teaching Hospital in India.

The indoor hospital use of antibiotic irrationally has been a growing concern in the recent past. For the patients and providers of health care services this kind of drug consumption account for a major chunk of the budget. To assess the outcome of restriction on the use of parenteral antibiotics with respect to their utilization and monetary benefits, in a tertiary care hospital in India. Data details were collected regarding drug utilization two months before and after restriction respectively. A total 1605 patient records assessed. Drug utilization was expressed as DDD/100 patient bed days. Use of Carbapenems were restricted to culture positive cases only. Antibiotics started for patients as per clinical judgment were issued for only five days. Culture sensitivity reports verified physically on a special indent form, before every antibiotic issued thereafter. Piperacillin-tazobactum (DDD/100 BD 1.72 before and 1.29 after restrictions) was the commonly used antibiotic. Considering values expressed in DDD/100 BD before and after restriction respectively, substantial decrease in consumption of antibiotics like Imipenem- Cilastin (0.22 to 0.16), meropenem (0.30 to 0.09), piperacillin-tazobactum (1.72 to 1.29), teicoplanin (0.24 to 0.05) and vancomycin (0.69 to 0.40) was observed. An increase in consumption of amoxicillin-clavulanic acid (0.90 to 1.04) and clarithromycin (0.44 to 0.55) noted, pointing to a shift in antibiotic use. Restriction decreased expenditure burden on these antibiotics by INR 1,45,911 (17.31%). Restriction of antibiotics cuts down consumption and benefits hospital budget immensely.

Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit

IntroductionA study is conducted on the impact of a Sepsis Code Hospital Protocol upon antibiotic use, hospital stay and mortality. DesignA quasi-experimental, retrospective observational study was carried out. SettingA polyvalent ICU with 11 beds belonging to a tertiary hospital. PatientsPatients admitted to the ICU with severe sepsis or septic shock. InterventionsA post-intervention group (POST-SC) (September 2012–August 2013) was compared with a historical control group (PRE-SC) (January–December 2010). VariablesType of antibiotic treatment, antibiotic therapeutic strategy and clinical outcomes. Antibiotic use was expressed as defined daily doses/100 stays. ResultsA total of 42 patients with severe sepsis or septic shock were included in the POST-SC group and 50 in the PRE-SC group. Total antibiotic consumption (defined daily doses) was similar in both groups. In the POST-SC group the gradual reduction rate was significantly greater (75% vs 30.8%; p<0.005), while the restricted use antibiotic prescription rate was significantly lower (74% vs 52%; p=0.031). Lastly, the POST-SC group presented significantly lower mortality both in hospital and after 28 days (23% vs 44% [p=0.035] and 31% vs 56% [p=0.01], respectively), as well as a decrease in ICU stay at the limit of statistical significance (5 vs 10.5 days; p=0.05). ConclusionThe implementation of a Sepsis Code Hospital Protocol was associated with improved antibiotic use, with a significant increase in gradual therapeutic reduction, a lower use of restricted use antibiotics, a significant reduction in mortality, and a tendency towards a shorter ICU stay.

Clinical Impact of an Antibiotic Stewarship Program at Two Non-Teaching Community Hospitals

BackgroundThe clinical impact of antibiotic stewardship programs (ASP) in non-teaching community hospitals (NTCH) is largely unknown. We report our experience in two NTCH with limited resources where ASP was established.MethodsIn 2008, ASP was established at two NTCH: University of Maryland-Upper Chesapeake Medical Center (UM-UCMC) and University of Maryland-Harford Memorial Hospital (UM-HMH) each with 195 and 128 beds, respectively.Empiric use of Level 1 antibiotics (piperacillin/tazobactam and vancomycin) was restricted to 72 hours, after which a positive culture or an ID consult was required to continue the antibiotics further. Empiric use of Level 2 antibiotics (carbapenems, echinocandins, tigecycline, daptomycin, linezolid, ganciclovir, voriconazole, lipid amphotericin and other non-formulary antibiotics) required an ID consult within 24 hours. Pharmacists reviewed restricted antibiotics and culture results, managed drug levels of vancomycin and aminoglycosides, and facilitated IV to PO conversions. Annual antibiograms were generated. Antibiotic utilization, cost, resistance patterns and rates of healthcare-associated (HA) C. difficile infections were tracked.ResultsRates of HA C. difficile infections decreased by 73%. Pseudomonas resistance to carbapenems, gentamicin, and piperacillin/tazobactam decreased by 62%, 56%, and 33% respectively. Enterococcus resistance to vancomycin, and the rates of extended spectrum β lactamase (ESBL) producing organisms remained stable. Total antibiotic purchase decreased by 30%; antibiotic cost per-patient-day decreased by an average of 41%. Physician compliance with our ASP was >90%.ConclusionImplementing an ASP at two non-teaching community hospitals not just reduced the overall utilization and cost of antibiotics, but also resulted in a significant reduction of healthcare-associated C. difficile infections and pseudomonas resistance to carbapenems and aminoglycosides.Figure 1Figure 2Figure 3Disclosures All authors: No reported disclosures.

Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos

IntroductionA study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DesignQuasi-experimental observational retrospective study. SettingPolyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PatientsPatients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. InterventionsA post intervention group (POST-SC) (September 2012–August 2013) was compared with a historical group (PRE-SC) used as control (January–December 2010). VariablesAntibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. Results42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05). ConclusionThe implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay.

Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection.

: Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. While the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance, evidence of the effect on outcome following severe infection is lacking. : In 2008, Glasgow hospitals introduced a restrictive antibiotic guideline. A retrospective before/after study assessed outcome following Gram-negative bacteraemia in the 2-year period around implementation. : Introduction of restrictive antibiotic guidelines was associated with a reduction in utilization of ceftriaxone and co-amoxiclav and an increase in amoxicillin and gentamicin. Approximately 1593 episodes of bacteremia were included in the study. The mortality over 1-year following Gram-negative bacteraemia was lower in the period following guideline implementation (RR 0.852, P = 0.045). There was no evidence of a difference in secondary outcomes including ITU admission, length of stay, readmission, recurrence of bacteraemia and need for renal replacement therapy. There was a fall in CDI (RR 0.571, P = 0.014) and a reduction in bacterial resistance to ceftriaxone and co-amoxiclav but no evidence of an increase in gentamicin resistance after guideline implementation. : Restrictive antibiotic guidelines were associated with a reduction in CDI and bacterial resistance but no evidence of adverse outcomes following Gram-negative bacteraemia. There was a small reduction in one year mortality.

Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study

This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.

Impact of antibiotic restriction on resistance levels of Escherichia coli: a controlled interrupted time series study of a hospital-wide antibiotic stewardship programme.

We evaluated the effect of an antibiotic stewardship programme (ASP) on the use of antibiotics and resistance levels of Escherichia coli using a method that allowed direct comparison between an intervention hospital and a control hospital. The study was conducted as a retrospective controlled interrupted time series (ITS) at two university teaching hospitals, intervention and control, with 736 and 552 beds, respectively. The study period was between January 2008 and September 2014. We used ITS analysis to determine significant changes in antibiotic use and resistance levels of E. coli. Results were directly compared with data from the control hospital utilizing a subtracted time series (STS). Direct comparison with the control hospital showed that the ASP was associated with a significant change in the level of use of cephalosporins [-151 DDDs/1000 bed-days (95% CI -177, -126)] and fluoroquinolones [-44.5 DDDs/1000 bed-days (95% CI -58.9, -30.1)]. Resistance of E. coli showed a significant change in slope for cefuroxime [-0.13 percentage points/month (95% CI -0.21, -0.057)] and ciprofloxacin [-0.15 percentage points/month (95% CI -0.26, -0.038)]. The ASP significantly reduced the use of cephalosporins and fluoroquinolones, with concomitant decreasing levels of E. coli resistance to cefuroxime and ciprofloxacin. The same development was not observed at the control hospital.

Assessment of Antibiotic Prescription Practices in a Tertiary Care Hospital

Background: Widespread and irrational use of antibiotics has caused microbials to acquire re-sistance and is an important public health problem to be urgently addressed. Hence there is a need to con-stantly monitor the prescription practices through audits and to initiate corrective measures. Objectives: To asses the antibiotic prescription practice in a teaching hospital. Materials and Methods : The prescrip-tions originating from medicine out patient department on one day in a week for five months were assessed for appropriateness in dosage, duration of treatment and use of fixed dose combination drugs (FDCs). The clinical diagnosis and patients details were recorded in a structured proforma. Results: Out of 650 patient prescription studied 180 patients (27.6%) received antibiotics. Among them 25.3% patients were pre-scribed one antibiotic and (18.8%) were prescribed antimicrobial FDCs. Out of the 180 prescriptions, 47% were irrational. The most commonly prescribed antibiotic categories were β-lactam antibiotics (35.1%), followed by fluoroquinolones (18.8%) and combinations of antibiotics from different groups (13.8%). Con-clusion: Higher frequency of irrational antimicrobial prescriptions suggests that antibiotic restriction poli-cies and a multidisciplinary effort to reduce usage are urgently required. Keywords: prescription practice, antibiotics, FDCs