Drug Utilization Evaluation Research Articles

A RETROSPECTIVE STUDY ON ANTIBIOTIC USAGE IN A TERTIARY CARE HOSPITAL

Antibiotics are one of the most commonly prescribed drugs today. Rational use of antibiotics is therefore extremely important as their injudicious use can adversely affect the patient. Drug Utilization Evaluation (DUE) is a system of ongoing systematic criteria based evaluation of drug that will help to ensure that medicines are used appropriately. It is drug/disease specific and can be structured so that it will assess the actual process of prescribing, dispensing, or administration of drug. The retrospective study was conducted At Pk Das Institute of Medical Sciences, Palakkad, Kerala for a duration of 6 months (February 2017 - January 2018). A source of data includes Patient case sheets &medication charts, nursing charts, culture & sensitivity reports. The inclusion criterion includes Patients aged between 18- 80 year, prescribed with oral and parenteral antibiotics. . On analyzing the gender, male gender (n= 111, 55.5%) were higher in numbers as compared to female counterparts (n=89, 44.5%). In our study the majority of the patients prescribed with antibiotics were with the clinical assessment of COPD (n=39, 19.5%), UTI (n=37, 18.5%) and LRTI (n=28, 14%), Bronchial asthma (n=19, 9.5%) respectively. On analyzing the data based on antibiotic sensitivity test, antibiotic test were performed and followed in (n=64,32%)prescriptions and in (n=47,23.5%)prescriptions were test is not followed respectively. In (n=89,44.5%) prescriptions, antibiotic sensitivity test is not performed. On analysis of antibiotics prescribed, the most commonly prescribed antibiotics were cephalosporins, of these ceftriaxone was highly prescribed of all (n=95). The high percentage of antibiotic prescriptions may indicate a high probability of irrational use. This study also point out irrational use of antibiotics are more leading to resistance, misuse and serious problems. So certain strategies should be put forward to strengthen rational use of antibiotics.
 Keywords: Antibiotics, Antibiotic Susceptibility Test, Irrational use, Resistance

Evaluation of the knowledge and opinions of university students in rational drug use

Objective: The aim of this study is to evaluate the knowledge and opinions of students at Sivas Cumhuriyet University on rational drug use. Method: In this study, 400 students at different faculties at Sivas Cumhuriyet University constituted the universe of this study. All students who agreed to participate in the study were included. A questionnaire consisting of 17 questions about rational drug use was prepared and students were allowed to participate in the survey with their own consent. Results: In our study, the responses of the participants to the questions in the questionnaire study were evaluated. According to the results, it was observed that the participants do not have sufficient information about rational drug utilization. It was observed 230 women participants and 170 men participants included in our study. Conclusions: As a result of the survey, the opinions of the participants were evaluated. According to the results obtained, the majority of the participants should be informed about rational drug use.

Prospective study of the prescribing pattern of antibiotics and their outcome in patients admitted to intensive care unit at tertiary center

Background: Antibiotics are currently the most commonly prescribed drugs in hospitals, worldwide. overuse of antibiotics has important economic implications. Periodic evaluation of drug utilization in the intensive care unit (ICU) is necessary for optimization of health care system, proper use of resources and making prescription policy because ICU is considered as the epi-center of antimicrobial resistance. The aim of this study is to evaluate antibiotic prescription and consumption patterns at admission into intensive care unit and to know the average costs of antibiotics.Methods: The prescription data on 250 consecutive patients at admission into the ICU was audited from January to March 2019. Total antibiotics, dose, route and cost of antibiotics were noted and the defined daily dose/100 bed days of most common antibiotics were calculated. Statistical analysis is done using SPSS software.Results: A total of 689 antibiotics were prescribed in the 250 patients studied that is, an average of 2.28 antibiotics/prescription. Empirical antibiotics were prescribed to all the patients admitted to ICU. Average cost of the antibiotics was rupees 163.89 per patients. The most commonly prescribed antibiotic at ICU admission was ceftriaxone (62%) of all prescription. Second most common is metronidazole (32%). In this study, 76 patients recovered while 174 patients expired.Conclusions: Our study reveals that antibiotics are widely prescribed in critically ill patients and form significant drug consumed in the ICU. At admission elderly patients are prescribed >2 antibiotics and prescribing antibiotics where the cost of antibiotic is high.

Assessment of antibiotics use for children upper respiratory tract infections: a retrospective, cross-sectional study from Pakistan

Background: Since drug utilization evaluation is essential to assess the appropriate use of medications, the present study was carried out to evaluate antibiotics use for children upper respiratory tract infections (URTIs).Methods: A retrospective, cross-sectional study was conducted in the six health care settings of central Punjab, Pakistan. Medical records of children ≤ 12 years who were admitted in the study settings from 1st Jan-28th Feb 2019 were reviewed. Patterns of antibiotic use were assessed in the light of the WHO prescribing indicators and appropriateness of antibiotics treatment was assessed from British National Formulary for children.Results: A total of 1843 cases of URTI were analyzed, containing 6635 total medications. All of the patients were given antibiotics (mean 1.94 ± 0.63 antibiotics). Cephalosporin was the most commonly used antibiotics class (37.8%) followed by penicillins. Injections were given to all the patients. Only 11% of the cases received appropriate therapy according to the indication. Of these (n = 204), around 93% received right dose whereas right frequency and duration were found in 96.5% and 95.5% of the cases, respectively.Conclusion: Our study revealed alarmingly high utilization of antibiotics among Pakistani children with URTIs. A great emphasis should be placed on implementing antimicrobial stewardship strategies for the rational use of antimicrobials in Pakistan and pharmacists should be in the front and centre to lead antimicrobial stewardship.

Drug Utilization Evaluation of Lorazepam in Alcohol Withdrawal Syndrome Patients: A Secondary Care Teaching Hospital Based Study

Background: Drug utilization evaluation is an important parameter for the safe, effective and rational use of medications in medical care. Alcoholism results in abundant cases of alcohol withdrawal which can prove to be life-threatening if untreated, lorazepam is a drug of choice for Alcohol Withdrawal Syndrome and requires close monitoring as its over-dosing or under-dosing is common in case of withdrawal. Objective: ensures the safe and rational use of Lorazepam in the management of Alcohol Withdrawal Syndrome. Materials and Method: This prospective, observational study was conducted among alcoholic patients admitted in the KC General Hospital, Karnataka, India. Baseline data for Clinical Institute Withdrawal Assessment for Alcohol revised scale (CIWA-Ar) was collected on the day of admission and the response to lorazepam treatment was recorded using the same with respect to the baseline data every 12th hourly after the initial administration until withdrawn. Results: Statistical analysis for 72 patients was done using ANOVA to calculate the overall progression of the syndrome with treatment. Among 72 patients 94.44% were male and 5.55% were female. The mean age of patients reported with AWS was found to be 44.90 years. A significant CIWA-Ar score reduction was observed with a p-value of <0.0001. Conclusion: Our study revealed a strong predominance of male patients with alcohol withdrawal syndrome, where maximum patients started consuming alcohol before the age of 20 years. After the administration of lorazepam, a significant CIWA-Ar score reduction was observed.
 Keywords: Alcohol Withdrawal Syndrome, CIWA-Ar scale, Drug utilization evaluation, Lorazepam.

Study of dental disease pattern and drug utilization evaluation among patients visiting dental outpatient department of tertiary care center

Background: Oral health has been an integral component of general health, with a serious impact on the quality of life and the overall well-being. Limited availability and accessibility of oral health services are risk factors for poor oral health and diseases. This study aimed to observe common dental disease pattern and to evaluate drug utilization pattern among patients visiting Dental Outpatient Department of Dhulikhel Hospital- Kathmandu University Hospital.
 Methods: A descriptive, cross-sectional study was conducted from October 2018 to January 2019 in Dental Outpatient Department of Dhulikhel Hospital-Kathmandu University Hospital. Two hundred forty prescriptions were collected and analyzed. Descriptive statistical analysis was carried out to find out common dental disease pattern and to evaluate drug utilization pattern.
 Results: Total 240 prescriptions were analyzed. Pulpitis 54 (22.5%) was the most common diagnosis, followed by periapical abscess 34 (14.16%). Out of 411 drugs prescribed, 166 (40.38%) were analgesics, 116 (28.22%) were antibiotics and 93 (22.62) were topical agents. Combination of paracetamol with ibuprofen was most commonly prescribed analgesics 133 (80.12%) and combination of amoxicillin with clavulanic acid was most commonly prescribed antibiotics 51 (43.97%). Out of all drugs prescribed, fixed dose combination was given in 194 (47.20%). Only 260 (63.26%) drugs were given by generic name and 133 (32.36%) drugs were from National List of Essential Medicines-Nepal.
 Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged.

A Drug Utilization Evaluation Study of Intravenous Acetaminophen in a Large Teaching Hospital

Background: Intravenous (IV) acetaminophen has become the most commonly chosen analgesic medication in critical care settings. Overall, the cost of the drug is higher than oral and rectal acetaminophen. As a result, numerous studies have been performed to evaluate the appropriateness of IV acetaminophen use based on guidelines. A lot of studies have shown that there is poor quality in compliance with guideline in developing countries. Current study aims to evaluate prescribing behavior of IV acetaminophen regimens in hospitalized adults in Tehran, Iran. Methods: We enrolled 277 patients (including 137 men and 140 women) with age ranged between 18-65 years. Demographic data and clinical and preclinical parameters such as blood urea nitrogen (BUN) and creatinine levels, name of ward, prescribing reason, doses, dose intervals, number of doses, type of vehicle used and durations of infusion were collected and recorded for analysis. Results: Our results have shown that guideline Adherence was seen only in 20 (7.22%) out of 277 patients. IV acetaminophen is prescribed mostly by emergency medicine specialists, and it is more inappropriately prescribed by these specialists in comparison to other specialists. It was also found that non-compliance of IV acetaminophen prescribing with guideline imposes additional 1038 USD for 3 months of the study. Conclusion: The evaluation of prescribing indicators showed low quality prescription by medical specialists. The pattern of prescribing depending on the medical specialties was also different. In addition, overuse and misuse of IV acetaminophen imposes substantial cost and the economic burden on healthcare system. J Pharm Care 2019; 7(4): 87-93.

Prescribing Patterns of Aminoglycoside Antibiotics in a Teaching Hospital in Sudan

Background: Aminoglycoside antimicrobials are widely used for the treatment of severe gram-negative bacterial infections. Their inappropriate use may result in treatment failure, development of resistant pathogens, and toxicity. Drug utilization evaluation of aminoglycosides can improve rational use. Purpose: This study intended to assess the prescribing patterns and potential problems associated with gentamicin and amikacin use. Methods: This prospective observational study was conducted at Soba University Hospital, Khartoum, Sudan. Patients’ demographics, clinical and prescription information were collected using a data collection form. Laboratory data of patients were collected from the patients' files. Ideal body weight was calculated to assess dose appropriateness, and adverse drug reactions were observed. Results: A total of 200 patients were included in the present study, two-thirds of the patients were prescribed gentamicin, while the remainder were given amikacin. Dosing was inappropriate in (60.6%) and (76.5%) of patients on gentamicin and amikacin respectively. Conventional dosing was used more commonly (67%) than extended dosing (33%). All indications for the use of these drugs were found to be appropriate. In (72%) of cases, both gentamicin and amikacin were prescribed based on microbiological sensitivity testing. Auditory function monitoring was only performed for neonates and infants. Nephrotoxicity was detected in 7 patients (9.3%), and ototoxicity in one patient (1.3%). Conclusion: Although prescription and dosing based on ideal body weight and microbiological data were reasonably common, higher compliance with recommended practice is needed in addition to therapeutic drug monitoring in order to ensure safe and effective treatment, and reduced antibiotic resistance.

EVALUATION OF CARBAPENEM USE AMONG PATIENTS AT INTENSIVE CARE UNIT (ICU) IN SANA'A, YEMEN

Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the rational use of medications. In this study, DUE has focused on drugs used in high risk patients such as critically ill cases. Carbapenems are beta-lactam type antibiotics with broad-spectrum of activity which cover gram-positive, gram-negative and anaerobic bacteria. The heavy use of carbapenems (imipenem or meropenm) could increase the risk of multi-drug resistant (MDR) pathogens. This study was a prospective and cross sectional study performed at intensive care unit (ICU) of Al-Matwakel hospital in Sana'a, Yemen. The study was conducted from September 2018 to March 2019. All of the patients were on imipenem or meropenem as an empiric treatment or based upon microbiology culture results included in the study. Total of 80 patients at ICU were evaluated. The results of the study showed that empiric therapy was in most cases (91.25%; P< 0.001).In addition; about 36.3% of the patients required dosage adjustment according to glomerular filtration rate (GFR) stages. Also according to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication of ceftriaxone with carbapenem was reported in 38 patients. The major drug-drug interactions were observed with tramadol-imipenem, tramadol-meropenem, and amlodipine-simvastatin. The result of the study showed that empiric therapy was unjustified in most cases (91.25%). In addition, about 36.3% of the patients required dosage adjustment according to GFR stages. According to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication and drug-drug interactions were observed.
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A STUDY ON DRUG UTILIZATION PATTERN IN OUTPATIENT GENERAL DEPARTMENT

Introduction: Drug utilization Review (DUR) also referred to be as drug utilization evaluation (DUE) and Drug utilization Pattern (DUP). It is defined as ongoing, authorized and systemic quality improvement process. WHO in 1977 defines drug utilization as “The marketing, distribution, prescription and use of drug in a society with special emphasis on resulting medical, social and economic consequences”. Drug utilization studies evaluate drug use at a population level, According to age, sex, social class. They provide feedback on drug utilization data to the prescribers. DUP Involves a comprehensive review of patient’s prescription and medication data before, during, and after dispensing to ensure appropriate medication decisions making and positive patient outcomes. Drug utilization pattern play a significant role in helping the healthcare system to understand, explain and improve the prescribing administration the use of medications. Pharmacokinetic and pharmacodynamics in general department differs in various age groups. The ultimate goal is to achieve rational and effective pharmaceutical care to the general department patients. This has resulted in a clarification of their uses, wider indications, and alternative methods of delivery. DU studies become one of the power full tools in evaluation of health system. Method: we conducted a single cantered observational and prospective analysis in general department patients age between 10-80 years at Sri sai niharika nursing home, old palnadu bus stand, narasaraopet. A total number of 1648 prescriptions were recorded. The drug data such as name of the drug, dosage-form, dosing frequency, route of administration were also noted. The results were presented as percentage. Conclusion: This study provides the information about the prescribing patterns of drug in general department patients. And conclude the role of clinical pharmacist is vital to be an integral part well as to clear the irrational use of drugs in general department. Pharmaceutical care is needed in the correct management of drugs which is even more important in case of general patients. The WHO core indicators helped to improvise the prescribing pattern, identify significant problems involved in the knowledge gap of patients or care takers understanding of instructions provided by consultants and even to minimize the cost burden on the patients.

Ebe ve Hemşirelerin Akılcı İlaç Kullanımına Yönelik Bilgi ve Davranışlarının İncelenmesi

OBJECTIVE: This study was conducted to examine the knowledge and behaviors of midwives and nurses in regards to rational drug utilization. METHOD: The descriptive and cross-sectional study was conducted in a training and research hospital of obstetrics and pediatrics, which accommodates 86 midwives and 49 nurses, from September 1 through October 1, 2017, with the participation of 27 midwives and 25 nurses (38.5%) totaling to 52 people. Granted the necessary permissions, data were collected by “Nurse / Midwife Self-Descriptive Form” and through face-to-face interviews, and were evaluated using descriptive statistical methods. FINDINGS: Of the participants of the research, 50.9% were midwives and 47.2% were nurses. The most frequent drug administration error encountered by 48% of the midwives and 32% of the nurses was found to be untimely administration of medication. It was determined that 81.5% of the midwives and 80% of the nurses know how to report side effects and that 77.8% of the midwives and 96% of the nurses have never reported any side effects. 81.5% and 80% of the midwives and the nurses, respectively, stated that prior to administering medication, they inquire whether patients have drug or food allergies; 34.6% of the midwives and 30.8% of the nurses stated that unused drugs were delivered back to the pharmacy; and all participants confirmed checking the expiration dates of drugs used in the medical service. Midwives and nurses were seen to consider good their level of knowledge in intended utilization of drugs, administration routes, and duration of the effects. CONCLUSION: It has been concluded that the knowledge and behaviors of midwives and nurses in regards to rational drug utilization are satisfactory but that there is a general need for training about rational drug utilization, especially drug administration and side effect notification.

REVIEW ON DRUG UTILIZATION PATTERN IN OUTPATIENT GENERAL DEPARTMENT

Drug utilization reviews DUR also referred to be as drug utilization evaluation DUE . It is defined as authorized, structured. Ongoing review of healthcare provider prescribing pharmacist dispensing and patient use of medication. Drug utilization reviews involve a detailed review of patient’s prescription and medication data before, during dispensing and after dispensing to ensure appropriate medication decisions making and positive patient outcomes. World health organization (WHO) defines drug utilization review as authorized research as the marketing, distribution, prescription and use of drug in a society, with a special emphasis on the resulting medical, social, and economic sequences. Inherent in the definition, such studies provide logical background for determining the rationality of drug use as well as providing the evidence based guidance for making the policies and making decisions at various levels of health care. This review studies are Aimed to discuss in detail on drug utilization pattern in out patient general department.

Drug Utilization Evaluation of Antibiotics Used in Orthopaedics Department in A Tertiary Care Hospital of Pathanamthitta District, Kerala

Drug Utilization Evaluation of Antibiotics Used in Orthopaedics Department in A Tertiary Care Hospital of Pathanamthitta District, Kerala

DRUG DISCHARGE AND GAUGING OF ANTI EPILEPTIC DRUGS

Background:Epilepsy is the second most common chronic neurological condition. Epilepsy means a tendency to have seizures i.e. recurrent unprovoked seizures. A seizure is a clinical events caused by an abnormal electrical discharge in brain (or) a transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in brain.Aims and Objectives: The main aim of the study is drug utilization evaluation of antiepileptic drugs among patients of different age groups in jayabharath hospital,Andhra Pradesh,. To assess drug utilization pattern of anti-epileptic drugs. METHODOLOGY:A prospective observational questionnaire based cross sectional study in 300 patients of various departments receiving atleastone AEDs. The subjects were included in the study only after they met the criteria for the study and after properly filling a informed consent form. The data was obtained by a questionnaire format and it is evaluated for utilization patterns, medication adherence. The cost of AEDs were calculated to evaluate total costs on each drug.RESULTS:Out of 300 patients, 210 were male and 90 were female. The age group 11- 20 years were found prominent with epilepsy. The average number of AEDs per patient was found to be 1.54. Among all the drugs prescribed phenytoin was the most common drug prescribed 223 (47.89%) for the treatment, followed by lorazepam 89 (19.09 %) and sodium valproate 40 (8.73 %). CONCLUSION:The use of AEDs was almost found to be rational. In this hospital the most commonly prescribed AEDs was phenytoin followed by lorazepam and in combinational therapy it was phenytoin + lorazepam. The utilization of drugs was obtained from the patients using questionnaire format and they showed high utilization of drugs.

National Survey of Pharmacy and Therapeutic Committee in Saudi Arabia: Formulary Management System

International Journal of Pharmacology and Clinical Sciences,2019,8,4,227-231.DOI:10.5530/ijpcs.2019.8.50Published:December 2019Type:Research ArticleAuthors:Yousef Ahmed Alomi, Sultan Mohammed Al-Jarallah, Rasha Abdelsalam Elshenawy, and Faiz A Bahadig Rph Author(s) affiliations:Yousef Ahmed Alomi*, The Former General Manager of General Administration of Pharmaceutical Care, The Former Head, National Clinical Pharmacy and Pharmacy Practice, The Former Head, Pharmacy R & D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. Sultan Mohammed Al-Jarallah, Head, Ambulatory Care Pharmacy, Oncology and Hematology Clinical Pharmacist, Pharmaceutical Care Department, Security Forces Hospital, Riyadh, SAUDI ARABIA. Rasha Abdelsalam Elshenawy, BCS. Pharm. BCPS (AQ-ID), CPHQ, M.Sc., TQM (AUC), SIDP, CEO of FADIC, Ministry of Health, Makkah, SAUDI ARABIA. Faiz A Bahadig Rph, Informatics Pharmacist, Pharmaceutical Care Department, King Abdulaziz Medical City-WR-Jeddah, Ministry of National Guard, SAUDI ARABIA. Abstract:Objective: Formulary management is an integrated patient care process which enables physicians, pharmacists and other healthcare professionals to work together to promote clinically sound cost-effective medication therapy and positive therapeutic outcomes. Effective use of healthcare resources can minimize overall medical costs, improve patient access to more affordable care and provide an improved quality of life. A formulary not only includes a list of medications and medication-associated products but also includes medication-use policies, important ancillary drug information, decision support tools and organizational guidelines. Therefore, in this study, we aimed to provide the guiding principles for the Formulary Management System at Ministry of Health (MOH) hospitals in Saudi Arabia. Methods: This is a 4-month cross-sectional national survey of Pharmacy and Therapeutic Committee at MOH hospitals in Saudi Arabia. The survey consisted of two parts: the first part collected demographic information and the second part contained 93 questions divided into four domains. The scope, structure and responsibilities, the formulary management system, the evaluation of drug formulary and decision-making and the committee meetings organization and management. The electronic survey was distributed to 50 drug information centers at MOH hospitals. It analyzed the formulary management system at MOH hospitals in Saudi Arabia through Survey Monkey system. Results: A total of 50 drug information centers responded to our questionnaire. The statement with highest score was related to the committee formulary system of medications usage through ensuring the safety of prescribing, distribution, administration and monitoring of medications (3.8); the process for managing drug product shortages (3.76); and the medications are requested for the addition or deletion from the drug formulary (3.68). Most of the hospitals had an open drug formulary (30 (60%)), with remaining responders having closed drug formulary (20 (40%)) with the total number of medications in the drug formulary (300–899) at 32 (64%) of the responded hospitals. The average score of type of method related to drug usage evaluation statements was 3.36, with the statement with high average score was review of medication error report (3.94) and review of medication sentinel incident reports (3.48), whereas the statement with lowest score was an investigational drug therapy approved (2.88). Conclusion: Two-thirds of the hospitals had open drug formulary. Drug utilization evaluation system should review for the majority of the hospital. update the formulary management system required with close monitoring for all MOH hospitals in Saudi Arabia. Keywords:Formulary Management System, Ministry of Health, National Pharmacy and Therapeutic Committee, Saudi ArabiaView:PDF (202.75 KB) PDFClick here to download the PDF file. Images National Survey of Pharmacy and Therapeutic Committee in Saudi Arabia: Formulary Management System

DRUG UTILIZATION EVALUATION OF BENZODIAZEPINES IN A TERTIARY CARE HOSPITAL

Objective: To assess the rationale use of benzodiazepines among various departments in a multi-speciality hospital.
 Methods: A prospective study was conducted with a sample size of 200 for a period of six months. Data was collected from patients based on inclusion and exclusion criteria. Naranjo Adverse Drug Reaction Probability Scale and Drug Interaction Probability Scale (DIPS) were used as a study tool to measure the causality of adverse drug reactions and drug interactions. Based on the dosage of various benzodiazepines DDD was calculated and compared with WHO Anatomical Therapeutic Chemical (ATC) classification Defined Daily Dose (DDD).
 Results: BZD’s were mostly prescribed in males (74.5%) and married patients (86.5%) were more exposed to benzodiazepines compared to others. Lorazepam (70.1%) was found to be the most commonly used drug, mainly prescribed for sedation, followed by anxiety. DDD was calculated and majority of patients had DDD in accordance with WHO standard. Based on cost analysis, Clobazam was found to be the high cost and Lorazepam being the low-cost drug. The results of drug utilization evaluation of benzodiazepines study were compiled and reported to the respected department physician and their feedback was collected.
 Conclusion: The study showed a rational utilization of benzodiazepines and the negative outcomes of BZDs can be reduced by providing drug-related information to the prescribers and consumers.

Drug Utilization Evaluation of Two Broad-Spectrum Antimicrobials: Cefepime and Piperacillin/Tazobactam in a Teaching Hospital in Tabriz, Iran

Background: The inappropriate use of antibiotic leads to microbial resistance, nosocomial infections and increased hospital costs. The present study was designed to evaluate DUE (Drug utilization evaluation) of cefepime and piperacillin-tazobactam drugs consumption patterns. Methods: This study was a descriptive and cross–sectional which performed 2014 on 140 hospitalized patients in Sina hospital Tabriz, Iran. Demographic data, duration of prescription, dose, dosage adjustment in renal impairment and accompanied prescribed antibiotics were extracted from medical files. UpToDate and American Hospital Formulary Service (AHFS) drug information 2012 were considered as standards of rational prescribing. Data analysis was performed by SPSS 18 software. Results: In 77.4% and 90% of the prescribed doses of cefepime and piperacillin-tazobactam for patients with guideline. The most common antibiotic administered with cefepime was ciprofloxacin (37 cases). In 21 patients, cefepime dosage should have been adjusted according to renal impairment, whereas it has done only in 16 (22.9%) patients. Culture was done in 60 (85.8%) cases. In 22(31.4%) patients, the result of culture was negative. Drug dosage and indication were appropriate in 34 (48%). The most common antibiotic administered with Piperacillin/tazobactam was vancomycin (45 cases). In 9 patients, Piperacillin/tazobactam dosage should have been adjusted according to renal impairment and it has done. Culture was done in 53 (75.8%) cases. In 9(12.8%) patients, the result of culture was negative. Conclusion: The results showed that there was an injudicious use of cefepime and piperacillin/ tazobactam at our hospital, evidenced by the significant number of inappropriate empiric prescriptions and drug modifications

Drug Utilization Evaluation of Vancomycin among Patients in Jafar Ibn Auf Pediatric Hospital, 2018

Background: Vancomycin is an antibiotic of growing importance in the treatment of hospital-acquired infections; with a particular emphasis on its value in the fight against Methicillin-resistant Staphylococcus aureus. Increasing reports of Vancomycin resistance have raised concerns about the effectiveness of this drug. Drug utilization evaluation has an important role in controlling rational use of antibiotics to prevent the emergence of resistance. Methods: We conducted a retrospective 6-months study at Jafar Ibn Auf pediatric hospital. Data including patient's demographics, diagnosis, Dosage regimen, and treatment duration were reviewed. The concordance of practice with the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and principles of antibiotic therapy was assessed. Results: 127 medical records were reviewed in this study. Sepsis (29%) and Pneumonia (19.6%) were the most common indications. Culture test was requested in 20.5% of patients. Monitoring of serum creatinine was carried in 81.1% of patients. Based on HICPAC guidelines vancomycin was administered appropriately in 67.7% percent of cases. Considering the infusion rate, most of patients with specific order were received vancomycin in 1 hour. Conclusions: The results showed that vancomycin was used empirically without subsequent adjustment of the antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to the infusion rate and serum creatinine monitoring.

Drug Utilization Evaluation of Cefepime and Meropenem Based on the Infectious Disease Society of America and Defined Daily Dose Guidelines at the Payambare-Azam Bandar Abbas Hospital: A Retrospective Study

Background: Given the significant consumption of antibiotics in hospitals and the likelihood of resistance, this study was designed to determine the pattern of meropenem and cefepime administration and prescription dose, according to Infectious Disease Society of America (IDSA) and WHO Defined Daily Dose guidelines, at Payambare-Azam Hospital in Bandar Abbas, Iran. Methods: A Retrospective study was performed from August 2016-March 2017, on 200 patients (100 patients receiving cefepime and 100 patients received meropenem) hospitalized in different wards of the hospital. A total of 189 patients were enrolled in the study, with was with consideration of the patients receiving the two antibiotics concurrently. Results: Of the examined patients, 58 (31%) were female and 131 (69%) male. In the group receiving meropenem and cefepime, 62% and 60% of the patients were above 50 years old, respectively. In terms of prescriptions, 85% cases of meropenen and 49% cefepime were performed according to the defined daily dose (DDD)’s guideline. Prescribing antibiotics for 170 (90%) of patients was empirical. Also, in the 176 (93%) patients, the dose was adjusted according to the creatinine clearance. Conclusions: Increasing the number of empirical therapy, regardless of microbial cultures and susceptibility profiles, suggests further prospective studies to evaluate the reason for this finding.

Drug Utilization Evaluation of Anti-Diabetic Medication through Prescription Monitoring

Diabetes is a chronic and potentially disabling disease that represents an important public health and clinical concern. The study was designed to assess the drug utilization evaluation of anti-diabetic medications through prescription monitoring in a tertiary care hospital at capital city Dehradun in a northern state Uttarakhand. Prescriptions from patients of diabetes were selected for the study and data was collected from patients using a questionnaire format. All the necessary and relevant information will be collected from out-patient prescriptions, laboratory data reports and also by verbal communication with patients. Out of total 100 prescriptions of diabetic patients, it was found that gender wise distribution of diabetic patients was more in females (64%) as compared to males (36%). Among 100 patients, type 1 diabetes occurred in 16% patients and type 2 diabetes occurred in 84% patients. It was also analyzed that both type 1 and type 2 diabetes were mostly occurred in females. Among type 2 diabetes patients, Glimepiride were mostly prescribed in 42% patients, followed by Metformin in 22% patients and Gliclazide in 20% while in type 1 diabetes patients, Human Insulin were prescribed in 16% patients. Prescription analysis showed that maximum prescriptions (50%) contain two drugs per prescription while six drugs per prescription were shown by only 2% prescriptions. This study may provide further help to prescribers for improvement in current prescribing trends in the management of diabetes mellitus.