Irrational Prescribing Research Articles

A Prospective Antimicrobial Prescription Audit in the Inpatient Department of Pulmonology in a Tertiary Care Hospital

Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic usage is increasing rapidly day by day with or without prescription. Irrational prescription usage, negligence of standard guidelines and antimicrobial resistance are increasing complexity in the therapy and the desired outcome. High-volume prescription of antibiotics in primary health care is a major factor contributing to antibiotic resistance. Educating physicians and patients can lower prescribing errors and the aim of this study was to do a prospective observational prescription audit in inpatient department of pulmonology in a tertiary care hospital and limiting the inappropriate use of antimicrobials. The primary objective of the study is to determine the Antibiotic prescription, find out the inappropriate drug selection, dose selection, dosage form and course of antibiotics to monitor the culture test as well as antibiotic sensitivity and resistance and also to analyze the drug interaction, allergic medication prescribed and omission of the dose. The study was conducted with 234 patients in Erode district, Tamilnadu. The study conducted by strictly observing the antimicrobial prescription in the inpatient pulmonology department in a tertiary care hospital, limiting the inappropriate drug selection, dose selection, dosage form, course of antibiotics and hence decreasing the antibiotic resistance. The prescribing and administering details were collected in a data acquisition form; the collected data were interpreted with Sanford and GOLD Standard Guidelines and analyzed with descriptive statistics. The study found that irrational use of medication was high (53.41%) and a highly significant medication error also reported. The major concomitant disorder was Chronic Obstructive Pulmonary Disorder (21.79%) and most administered drug was Ceftriaxone (20.51%) (Third generation Cephalosporins). Culture test (32.90%) as well as antibiotic sensitivity and resistance test were done in very less cases, empirical therapy dominates over targeted therapy which affects rationality.

Effects of monthly evaluations on the rates of irrational antimicrobial prescription in the outpatient and emergency departments at Ningbo No. 6 Hospital, Ningbo, China

BackgroundAntibiotic resistance is a major global public health problem. The primary cause of antibiotic resistance is inappropriate antibiotic use. In this study, we aimed to verify whether the monthly evaluation of antibiotic prescription improves clinical antibiotic use in outpatient and emergency departments.MethodsA minimum of 25% of the prescriptions for antibacterial drugs were randomly selected at the outpatient and emergency departments to enter the monthly evaluation system from July 2016 to June 2019. We analysed the rate of irrational prescription of antibiotics, proportion of the use of antibiotics, and consistency between the evaluation and expert groups after implementing the monthly assessment to validate the role of monthly evaluations.ResultsAfter 3 years of monthly evaluations of antibiotic prescriptions, the utilisation rate of single antibiotics in the outpatient and emergency departments was found to increase each year. Each year, a decreasing trend was observed for the irrational use of antibiotics, whereas the proportion of antibiotics to the total drugs prescribed gradually decreased in the same period. In addition, the consistency of prescription evaluation results between the evaluation and expert groups increased continuously.ConclusionsMonthly evaluation of antibiotic prescriptions is an effective management tool for the rational use of antibiotics in clinical practice. This practice could help reduce the combinative use of antibiotics, rate of irrational antibiotic prescription, and antibiotic use ratio, and play an important role in safe clinical drug use.

Irrational prescription of surfactant replacement therapy in neonatal respiratory distress.

PurposeRespiratory distress is known as one of the leading causes of neonatal death. In recent decades, surfactant therapy has revolutionized respiratory failure. Since the implementation of the health system reform plan as well as the allocation of new financial resources for health system in Iran, the rate of irrational prescription has increased and prescription of surfactant for neonates, has raised unexpectedly, which is thought to be due to irrational prescriptions partly. The present study aimed to determine the rate of irrational prescription of surfactant for neonates with respiratory distress.MethodsThis research was a cross-sectional descriptive study, which was conducted retrospectively. In the current study, determining the rate of irrational prescription was done in terms of the surfactant prescription guideline. Finally, the medical data of 846 neonates who underwent surfactant therapy in Iran in 2018, were extracted from the information system of the Ministry of Health and the neonatal medical records.ResultsThe results show that drug selection index, dose index, and time index were irrational for 14.30%, 27.42%, and 1.06% of neonates, respectively. Moreover, the total index of drug prescription, which is a combination of the above-mentioned three components, was found to be irrational for 31.47% of neonates.ConclusionsThe results of the present study are considered as a warning to providers and decision makers in the field of neonatal health to reduce irrational prescriptions of surfactant for neonates. This study suggests the use of educational interventions in order to reduce irrational prescriptions due to drug selection as well as the use of computer alert approaches in order to reduce irrational prescriptions due to wrong dose.

Health facility practices and patterns of prescription influencing health-seeking behaviour among caregivers of children diagnosed with pneumonia in Endebess Sub-county, Kenya

Background Pneumonia accounts for 16% of all child deaths in Kenya, and it is the second killer of children under the age of five. Pneumonia burden is attributed to inadequate access to healthcare and poor health-seeking by caregivers. Endebess caregivers report delays of 1-14 days and subject their children to medicine from shops before visiting a hospital, as evidenced by the history of the presenting illness in patient files. In addition, irrational prescription has been demonstrated regardless of clinical guidelines. This study explored health facility practices and drug prescription patterns that influence health-seeking behaviour in Endebess Sub-county, Kenya. Methods A cross-sectional study involving 273 caregivers accompanied by a qualitative study on 24 health personnel was conducted from May to August 2019. Using a simple random sampling technique, a questionnaire was administered to caregivers visiting the health facilities. Key informant interview guides were also conducted with health care personnel. Quantitative data were analysed using logistic regression, whereas qualitative data were analysed by searching for emerging themes on health facility practices and prescription patterns across health facilities. Results Overall, stratification by health facility practices revealed that there were numerous significant results at the level of P<0.001, including the availability of drugs, administration of a starting dose, type of drug prescribed, willingness to recommend the facility, place caregiver seeks treatment (P=0.005) and facility of choice (P=0.001), which all influenced willingness to revisit the hospital. In relation to health information, the significant results at the level of P<0.001 included adequate instructions, the confidence of the caregiver to give the correct dosage at home, satisfaction levels and shared decision making on choices of antibiotic therapy (P=0.005) were associated with a higher willingness to revisit the hospital. There was a varied pattern of prescriptions for antibiotics. Consistently the odds of willingness to revisit the hospital increased among caregivers who had an injection medication prescribed for their children (P=0.380; odds ratio, OR=2.06, 95% confidence interval, CI=0.41-10.42) relative to those on oral medication. Conclusions There is a need for strict control of prescribing antibiotics in children under five years. Shared decision making on the choice of therapy should not be limited to chronic illnesses.

Pharmacist-led medication therapy management of diabetes club patients at a primary healthcare clinic in Cape Town, South Africa: A retrospective and prospective audit

Background. Diabetes mellitus (DM) is a complex chronic condition and remains a public health concern worldwide. In South Africa (SA), many patients with DM access public sector primary healthcare clinics, and those who are considered to be stable are referred to the club system, which is managed by a multidisciplinary team. Patients who have DM are often diagnosed with concurrent medical conditions, resulting in multiple medication therapies that lead to medication therapy problems (MTPs). Prescriber adherence to standard treatment guidelines (STGs) is aimed at improving glycaemic control to minimise complications and decrease healthcare costs. The pharmacist’s role in medication therapy management (MTM) for DM is underutilised in public sector healthcare facilities. Objectives. To evaluate the implementation of a pharmacist-led MTM intervention to optimise the management of stable patients with type 2 DM attending a diabetes club at a Cape Town community day centre. Methods. An evaluation study design using a case study approach was conducted over 8 months from November 2016 to June 2017. A retrospective and prospective audit was conducted from patient folders of stable patients who attended the club. Quantitative data were extracted from the folders. A trained pharmacist audited baseline (pre-intervention) data. Prescribing staff were notified of therapeutic discrepancies through written pharmacist’s pharmacotherapeutic recommendations (intervention). Pharmacist-led interventions audited prescriber adherence to SA STGs and the Essential Medicines List, and prescriber responses to the pharmacist’s recommendations (post-intervention) were recorded as accepted, partially accepted or rejected. Estimated costs were calculated for rational and irrational prescribing of aspirin during the MTM process. Results. Of 104 patient folders audited, most were for females (n=70; 67.3%). A total of 453 MTPs were identified, averaging four interventions per folder reviewed. The most common MTPs identified were the absence of basic clinical data: body mass index not documented (22.5%) in the folder, no medical indication noted (19.2%), and laboratory tests not requested (18.3%) by clinicians. Prescriber acceptance of the pharmacist’s recommendations was found to be low (26.8%), suggestive of clinical inertia. Aspirin was found to be irrationally prescribed to patients with DM (15.4%). Conclusion. Pharmacists can identify, resolve and prevent MTPs and rationalise appropriate medication therapy in patients with DM. Prescriber uptake of pharmacists’ pharmacotherapeutic recommendations seems overlooked. Pharmacist-led workshops to advocate for rational prescribing are needed to mitigate MTPs among stable patients with type 2 DM at public sector healthcare facilities.

P14 The antibiotic resistance profile of bacteria causing acute respiratory tract infections in Khartoum, Sudan

BackgroundAcute respiratory tract infections (ARTIs) are the most common indication for antibiotic prescriptions. This is associated with irrational prescription and correlated with antimicrobial resistance especially in low-income countries including Sudan. This is a cross-sectional study aimed at identifying bacterial pathogens causing ARTIs and their susceptibility to the commonly prescribed antibiotics.MethodsBacterial pathogens (51 isolates) were obtained from 29 ARTI patients from two hospitals in Khartoum in the time period March 2021 to March 2022. Samples were collected from each patient using both nasopharyngeal and oropharyngeal swabs. They were then cultured using blood and chocolate agar. The isolated colonies were identified using Gram staining technique, biochemical test, and selective media. Antibiotic susceptibility tests (AST) were done using the Kirby–Bauer disc diffusion susceptibility test protocol. Susceptible strains were determined following CLSI guidelines. The susceptibility of isolates was determined for different antibiotics representing the important classes including co-amoxiclav, cefixime, penicillin G, oxacillin, ceftriaxone, erythromycin, levofloxacin, ciprofloxacin and meropenem.ResultsIsolates were found to be mostly (82.3%) Gram positive (Staphylococcus aureus and Streptococcus pyogenes). Pseudomonas aeruginosa was the most abundant (17.9%) Gram-negative bacteria. S. aureus isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and meropenem. S. aureus exhibited less susceptibility to ceftriaxone (75%), and the least susceptibility to co-amoxiclav (37.5%), cefixime (31.3%), oxacillin (18.8) and erythromycin (25%). S. pyogenes isolates were found to be completely susceptible (100%) to co-amoxiclav, levofloxacin, ciprofloxacin and ceftriaxone. S. pyogenes had less susceptibility to vancomycin (92%), and the least susceptibility to cefixime (38.5%) and erythromycin (26.9%). P. aeruginosa isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and ceftriaxone, with less susceptibility to ceftriaxone (66%) and the least susceptibility to co-amoxiclav (22.2%), cefixime (33.3%), erythromycin (11.1%), vancomycin (11.1%) and oxacillin.ConclusionsCo-amoxiclav is extensively used in Sudan empirically. The results show that S. aureus and P. aeruginosa are increasingly becoming resistant to this drug. However, S. pyogenes is still susceptible to it. Conversely resistance to erythromycin and cephalosporins is shown in all the different isolated species, however these drugs are still widely used without even culture and ASTs. Luckily, non-susceptibility to ciprofloxacin and levofloxacin was not detected here. Obviously, laboratory identification and ASTs are much needed along with surveillance programmes in hospitals. Together with rational use of antibiotics these measures will help to slow down the progress of the deadly AMR pandemic.

A Multicentric Survey of Indian Medical Students about their Knowledge and Perception on Antimicrobial Stewardship

Antimicrobial stewardship (AMS) and appropriate infection prevention practices are essential to decrease the rising trend of antimicrobial resistance (AMR). Good antimicrobial prescribing habits formed early in the medical career can make a paradigm shift in combating the menace of AMR. Scarce data is available about the knowledge and perceptions of Indian undergraduates on AMS. This study was planned to analyse the knowledge, attitude and perceptions (KAP) of Indian medical undergraduates on rational antimicrobial prescribing, so that the lacunae in the training curriculum can be identified and addressed effectively. A cross-sectional questionnaire-based survey was carried out, on the pre-final and final year medical students (6th to 9th semester) from six medical colleges across different states of India. A scoring system was used to rate the knowledge, attitude and perceptions of the respondents as poor, average, or good. A total of 1505 students (83.61%) participated in the survey. Majority of the students (81.7%) from all medical colleges favoured more education on antimicrobials and to incorporate AMS in the undergraduate curriculum through integrated teaching. The results showed that overall, 70.9% students had a “good” score for knowledge on antimicrobial use, whereas only 55% scored “good” for being confident in rational antimicrobial prescribing. Surprisingly, only 56.5% correct responses for knowledge on selection of broad-spectrum antibiotics over narrow-spectrum antibiotics were recorded in our study. Most of the students (79.9%) were conscious that irrational prescribing can result to AMR. On the other hand, 54.9% students believed that the supply of new antimicrobials would take care of AMR eventually. 78.1% of our students believed that they were confident in making the right diagnosis of infection, whereas, 63.7% of respondents believed that they were not confident in identifying the clinical scenarios where antibiotics are not required. Significant association (p<0.05) was seen for both “good” knowledge and perception scores with the higher academic semesters reflecting more clinical exposure in later in course semesters. The study has highlighted the areas of clinical weakness and dilemma regarding prescription of antimicrobials. Efforts to address these issues on basic principles of antimicrobial stewardship, is critical for laying the foundation of successful AMS program and contributing in overcoming the antimicrobial resistance. The study recommends targeted training, articulating fine details of prescribing antimicrobials with real time case scenarios through a multi-disciplinary approach. The Indian undergraduate medical curriculum needs to incorporate early well-structured training on AMS by integrating pharmacology and microbiology teaching with the clinical subjects to ensure appropriate antibiotic prescribing practices by the future prescribers.

Drug Prescription Pattern in a Primary Care Clinic, Southwest, Nigeria

Background: Rational drug use is of the utmost importance in a region such as West Africa, where the prevalence of drug resistance is increasing due to inappropriate use of medications. 
 Objective: This study aimed to assess the pattern of prescription drug use at the General Outpatient Clinic of the University College Hospital, Ibadan. This study also assessed the knowledge and attitude toward rational drug use among prescribing physicians in the Clinic. 
 Design: The study was a retrospective cross-sectional review of patients' records over three years. The medical records were selected by systematic random sampling and subjected to the WHO core drug use indicators. Prescribers at the study site had their knowledge, attitude, and practice (KAP) of rational drug use assessed with a self-administered questionnaire. 
 Results: A total of 795 medical records were analyzed for drug use indicators. The mean number of drugs per encounter was 2.64 ±1.23. The percentage of encounters in which an antibiotic was prescribed was 20.4%, while 71.6% of all drugs prescribed were in the generic form. From the KAP survey, 64% of physicians routinely prescribed both generic and brand names, and 68% admitted they needed further education on rational drug use. 
 Conclusion: Using the WHO core drug use indicators, this study identified some degree of polypharmacy and poor adherence to the generic prescription of drugs. Continuing Medical Education for health workers is encouraged to stem the irrational prescription of medications in the African sub-region. 
 Keywords: Prescription Drugs Use, Rational Use of Medicines, Physician's knowledge, Nigeria

Recognizing benzodiazepine poisonings and providing appropriate treatment

Viktorija Antonova-Šiaudvytė1 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania Abstract Benzodiazepines are psychotropic drugs whose indications for use include short-term anxiety or insomnia, withdrawal syndrome, etc. Benzodiazepines selectively act on the central nervous system by causing depression. Benzodiazepine intoxication is manifested by increased sedation, sluggishness, dysarthria, ataxia, diplopia, tachycardia, and at higher doses may cause coma, respiratory depression or death. Flumazenil is administered only in cases of accidental poisoning, otherwise life support is used. Gastric lavage should be performed no more than 1 hour after ingestion. Activated charcoal or haemodialysis shows no signifficant effect. Due to the frequent prescription of these drugs and the development of dependence, it is necessary to have a good knowledge of the clinical signs of poisoning caused by these drugs and to be able to administer treatment. Aim: review the mechanisms of action, signs of intoxication and treatment tactics as described in the scientific literature. Conclusions: Benzodiazepines have become one of the most commonly prescribed group of psychotropic drugs in recent years. Although the use of these drugs has significantly decreased in Lithuania, irrational prescribing and use of anxiolytics is still observed. The mechanism of action of benzodiazepines is CNS depression, and intoxication is manifested by increased sedation, sluggishness, dysarthria, ataxia, diplopia, tachycardia, and at higher doses can cause coma, respiratory depression or death. Flumazenil is administered only in cases of unintentional poisoning, otherwise life support is used. Gastric lavage is possible less than one hour after ingestion. Activated charcoal or haemodialysis is not significantly affected. Methods: the international databases Pubmed and UpToDate were used for literature search. The following keywords or a combination of keywords were used in the search: benzodiazepines, indications for benzodiazepines, pharmacology of benzodiazepines, toxicity of benzodiazepines, benzodiazepine poisoning and treatment. Although every effort was made to analyse publications from the last 5 years, the citation period was not restricted. The results of the analysis of 19 articles out of 274 selected are presented in this article. Keywords: benzodiazepines, poisoning, flumazenil.

Antibiotic prescription rationality and associated in-patient treatment outcomes in children under-five with severe pneumonia at Bwizibwera health center IV, Mbarara District, South-Western Uganda

BackgroundPneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia. Pneumonia accounted for approximately 16% of the 5.6 million under-five deaths word wide in 2016. In Uganda, it kills approximately 2,400 children per year. Early diagnosis and appropriate case management with rational use of antibiotics remain the most effective intervention to reduce pneumonia-related mortality. This study aimed at determining antibiotic prescription rationality and associated in-patient treatment outcomes in children aged 2–59 months with severe community-acquired pneumonia at Bwizibwera Health Centre IV from 1st May 2018 to 30th April 2019.MethodsWe conducted a retrospective cohort study design; data were collected from in-patient records of all children aged 2–59 months with severe community-acquired pneumonia who met the eligibility criteria for a period of one year. Data abstraction template was used for data collection. Health care records of children aged 2–59 months who had other co-morbidities and were on medication that could influence or impact on in-patient treatment outcomes from 1st May 2018 to 30th April 2019 were excluded. Data was entered and analyzed using Epi-info v 7.2 and STATA v 13.0 respectively, Descriptive statistics were reported and Chi-square test was used to compare the proportions.ResultsOf the total records of children retrieved and screened (N = 847), 229 prescription records of children fulfilled inclusion criteria, 57 (24.9%) had rational prescriptions with good outcomes and 172 (75.1%) had irrational prescriptions with 10 (4.4%) having unfavorable outcomes. The majority (73.7%) of those who received rational prescription were on treatment with a combination of benzyl penicillin plus gentamycin while (26.3%) were on ampicillin plus gentamycin. The majority (32.4%) of patients with good treatment outcomes were aged 6 – 11 months. This age category also doubled as the group that experienced the highest percentage (40.0%) of unfavorable outcomes. There were no statistically significant associations between patient characteristics and treatment outcomes.ConclusionIn conclusion, the majority of children had irrational antibiotic prescriptions and 40 percent of children aged 6–11 Months had unfavorable treatment outcomes with 20 percent death. This study also found out that majority of antibiotic prescription among children under five was irrational and it’s against Uganda clinical guideline for treatment of severe pneumonia among children under five.

A critical evaluation of promotional drug literatures available with prescribers at a tertiary care teaching hospital in Gujarat, India

Background: Promotional literature provided by the pharmaceutical companies is one of the important marketing strategies to prescribe. Many of these literatures do not follow ethical guidelines and contain biased and irrelevant information that may cause irrational prescribing. So we did this study with an aim to check the credibility, reliability and authenticity of the PDLs available with prescribers.Methods: Promotional drug literatures were analyzed based on various parameters and guidelines provided by world health organization. Statistical analysis was done using Microsoft Excel.Results: A total 395 promotional drug literatures were analyzed and very few of them fulfilled the ethical criteria for drug promotion. Most of them focused on providing information about generic name, brand name manufacture company name and claims about efficacy. Few of them focused on safety of drugs as less information provided about adverse reaction, precaution and drug-drug interaction. Many of them contain space occupying unnecessary pictures.Conclusions: It can be concluded that the majority of the promotional advertisements that were given to the prescribers do not follow ethical guidelines and were not able to improve rational prescribing but only have commercial benefits.

Diagnostic significance of the determination of streptococcus pneumoniae antigen in the urine of children with community acquired pneumonia

Community-acquired pneumonia remains an urgent problem in modern pediatrics. Taking into account the variety of pathogens of community-acquired pneumonia, an important task is to identify the etiology of this disease rapidly. Early diagnostics is able to increase the effectiveness of treatment and exclude the irrational prescription of antibacterial drugs or the formation of resistable microflora. Traditional methods of etiotropic diagnostics do not always meet such criteria as timeliness, minimal invasiveness, and simplicity of reproduction. Meeting these requirements is especially important in pediatric practice due to the difficulty of venous access, collection of spontaneous or induced sputum and negative childhood denial reaction to invasive manipulation. Recently, active efforts have been made to identify the early markers con-firming the etiology of pulmonary inflammation, while the criteria for timeliness and non-invasiveness are met by methods for determining pathogen antigens in accessible media such as saliva and urine.Considering the fact that Streptococcus pneumoniae remains one of the main causative agents of pneumonia, its testing is of great practical importance. This article presents an overview of modern methods of etiotropic diagnosis of community-acquired pneumonia and the results of our own study of the effectiveness of detecting pneumococcal antigens in urine using express tests. Attention is focused on the use of minimally invasive methods for identifying the pathogen in practical pulmonology. Evaluation of the effectiveness of rapid testing was carried out in comparison with the results of bacterial sputum culture for pneumococcus. The analysis of the obtained results showed the high sensitivity and specificity of the Alere Binax Now test when checking the etiology of community-acquired pneumonia in children.

Analisis Penggunaan Obat Rasional Dalam Peresepan Pada Kasus ISPA Non Pneumonia Di Rumah Sakit Umum Dr. Pirngadi Kota Medan

RSUD DR Pirngadi Medan has a large number of cases of non-pneumonia ARI in Medan city and found some irrational drug prescriptions by doctors. This study aims to analyze drugs by doctors in prescribing rational drug use in cases of ARI Non Pneumonia. This research is quantitative. The study took place from July-August 2020. The research population consisted of all general practitioners, pulmonary specialists, pediatricians and internal medicine specialists totaling 79 people. The survey data were analyzed using the Chi-Square test and linear regression. Based on the results of the study, it was found that there was a relationship between prescribing drugs by doctors based on correct diagnosis (p = 0.000), there was a relationship between prescribing drugs by doctors based on appropriate indications (p = 0.000), there was a relationship between prescribing drugs by doctors based on the exact type of drug (p = 0.000) , there is a relationship between prescribing drugs by doctors based on the right dose (p = 0.000), there is a relationship between prescribing drugs by doctors based on the correct assessment of the patient's condition (p = 0.000), there is a relationship between prescribing drugs by doctors based on accurate information (p = 0.000), there is a relationship prescribing drugs by doctors based on appropriate follow-up with rational drug use (p=0.000). The conclusion in this study is that all variables in this study are related to rational drug use in cases of ARI Non Pneumonia and the most dominant variable is the correct information variable. Research suggestions are to make improvements to patient records so that patient profiles are easier to see and therapeutic decisions are easier and more accurate

A survey on knowledge, attitude, and practice about antibiotic prescribing and resistance among medical practitioners in Kenya

Background Antibiotic resistance is a growing global health threat worldwide and especially in developing countries. Irrational antibiotic prescription as well as lack of the requisite knowledge and awareness of proper antibiotic use are major drivers of antibiotic resistance. In Kenya, although the Ministry of Health has developed antibiotic use guidelines, these guidelines are not widely followed. Antibiotic prescription is, therefore, hugely at the discretion of the clinician. It is thus necessary to understand the knowledge, attitude, and practices (KAP) of antibiotic prescription among medical practitioners in the country. This study aimed to evaluate the knowledge, attitude, and practices (KAP) among antibiotic prescribers in three counties (Kiambu, Nakuru, and Bungoma) in Kenya. Methods This was a cross-sectional study using a self-administered questionnaire. Simple descriptive statistics were used to generate frequencies, percentages, and proportions. Where necessary, univariate analyses such as Pearson’s chi-square were performed to compare proportions for statistical significance. Results From the three counties, 240 respondents recorded their responses: 30% from Kiambu, 34.6% from Nakuru, and 35.4% from Bungoma. The respondents included 19 (7.9%) consultants, 66 (27.4%) medical officers, 135 (56.3%) clinical officers and 20 (8.3%) pharmacists. Of all respondents, more than 90% agreed or strongly agreed that antibiotic resistance (ABR) is a catastrophe worldwide and in Kenya. However, the proportion of the respondents who either agreed or strongly agreed (71.6%) that antibiotic resistance is a problem in their respective health facilities was significantly lower (ρ=0.013). Conclusion This study revealed that most medical practitioners were aware and knowledgeable about antibiotic resistance. However, there was a disconnect with mitigation measures such as active antibiotic stewardship and laboratory analyses to support judicious prescription. There is, therefore, a need for continuous education and stewardship interventions.

Prescribing Practices of Antibiotics for Acute Diarrhea in Children Aged Less than Five Years Old in Pakistan

Introduction: Childhood diarrhea accounts for 16% of child deaths in Pakistan. Irrational prescribing of antibiotics, prescribing of antibiotics for viral infections, self-medication using antibiotics, prescription sharing, and refilling are very common practices in Pakistan. The aim of this study was to evaluate the prescribing practices of antibiotics for acute diarrhea in children less than five years of age at a Secondary Healthcare Hospital of Pakistan and to assess the compliance of prescribers with authentic clinical guidelines of treatment for childhood acute diarrhea. Method: A cross-sectional study was conducted for a period of one year, from August 2020 to August 2021, at a Secondary Care Hospital of Karachi, Pakistan. It was based on the collection of outpatient clinic prescriptions of children aged less than five years and suffering from acute diarrhea. The regimens or suggested therapies by prescribers for acute diarrhea were assessed as per The National Institute of Care and Health Excellence and World Health Organization guidelines. A brief questionnaire was also distributed among prescribers, pharmacists, and caretakers of children to extract their opinions regarding antibiotic prescribing in acute diarrhea.Results: Antibiotics were inappropriately prescribed for acute diarrhea among children in Pakistan because p-value was less than 0.05 (p<0.05) as calculated by descriptive statistical tools using Z-test. More than 90% prescriptions of acute diarrhea in children less than five years of age failed to comply with the authentic treatment guidelines.Discussion: Due to the limited knowledge of prescribers regarding treatment guidelines and compliance of parents with antibiotic prescribing for diseases in children, irrational prescribing of antibiotics for acute diarrhea in children less than five years of age is frequent in Pakistan. Healthcare professionals must be adequately trained to ensure the proper management of acute diarrhea by following authentic clinical guidelines. Conclusion: Antibiotics are irrationally prescribed for acute diarrhea in children less than five years of age in Pakistan and prescriptions do not comply with authentic clinical guidelines.

RATIONALITY OF ANTIBIOTICS USE WITH QUANTITATIVE AND QUALITATIVE METHODS AT HOSPITAL IN INDONESIA


 Infection is one of the biggest causes of death in Indonesia which can be influenced by the appropriate use of antibiotics. Irrational use of antibiotics can cause bacteria to become resistant to antibiotics so that the effectiveness of the drug decreases or even disappears. This study aims to evaluate the use of antibiotics given to inpatients at a private hospital in Indonesia both quantitatively and qualitatively in the period July to December 2021. This study is an observational study with retrospective data collection where qualitative analysis using the Gyssens Method and quantitative analysis uses the DDD method. The results of the qualitative analysis showed that from 30 cases observed, there were 9 cases (30%) irrational prescriptions, namely 1 case in category V, 4 cases in category IVA, 2 cases in category IIIB and 2 cases in category IIA. The results of the quantitative analysis showed that the antibiotics with the highest DDD/100 patient days in the period July to December 2021 were Ceftriaxone with a successive value of 39.15; 39.81; 36.22; 55.65; 41,48 and 49, 42 while antibiotics with the lowest DDD/100 patient-days values in the period July to December obtained different results. Based on research results, there are irrational antibiotic prescriptions and Ceftriaxone became the most commonly prescribed antibiotic.
 
 
 
 
 
 
 
 
 

Audits of Antimicrobial Usage in a Tertiary Care Center in Hyderabad.

BackgroundIrrational prescriptions have an ill effect on health as well as on healthcare expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. Regular and timely audits of antibiotic prescriptions can prevent irrational antibiotic usage.IntroductionThe inappropriate use of drugs is a global health problem, especially in developing countries like India. In 2015, during the 68th World Health Organization (WHO) Regional Committee for Southeast Asia, all Member States of the region, including India, endorsed the “Regional Strategy for Patient Safety in the WHO Southeast Asia Region (2016-2025)” aiming to support the development of national quality of care and patient safety strategies, policies, and plans and commit to translating those objectives of the Regional Strategy into actionable strategies at country level.MethodologyA retrospective observational study was conducted in a 330-bedded, National Accreditation Board for Hospitals & Healthcare Providers (NABH)-accredited tertiary healthcare center. The study period was six months, from January 2019 to June 2019.ResultsNinety-five point four-five percent (95.45%) of the doctors attended the sensitization program and all accepted following the standard prescribing protocols. Sixty-nine point seven percent (69.7%) of the doctors were aware of the availability of drugs in the hospital pharmacy stores. Seventy-four point two-four percent (74.24%) of the doctors were aware of the ongoing prescription audits. Seventy-two point two-seven percent (72.27%) of the treating doctors were of the opinion of selecting the appropriate antibiotics based on hospital antibiogram. The importance of antibiograms from cultures and environmental surveillance was followed well only after sensitizing all the treating doctors. Ninety-five point four-five percent (95.45%) of the doctors were of the opinion of taking the permission of a higher authority to start high-end antibiotics. Seventy-seven point one-zero percent (77.10%) doctors recommended sample collection prior to antibiotic administration. Sixty-three percent (63%) of the patient’s clinical condition improved with the antibiotics prescribed prior to the culture report.ConclusionBy judicious use of antibiotics, we can reduce the evolution of antibiotic resistance in bacteria and extend the useful life of antibiotics that are still effective. Antibiotic use patterns must be studied to address complications resulting from a large number of antibiotics.

Applying the Kirkpatrick model to evaluate dental students' experience of learning about antibiotics use and resistance.

"Antibiotic resistance" is of main concern in global health and that it could hinder the achievement of sustainable development goals. One of the reported contributing factors is the irrational prescribing behaviour of healthcare professionals including dentists. Efforts to design and evaluate effective educational programmes for undergraduate dental students about appropriate prescribing behaviour during their early educational years could mitigate the risk of antibiotic resistance. A total of 322 students participated in the study. Their knowledge of antibiotics and antibiotic resistance was assessed. Students received a specially designed, interactive educational programme. The success of the programme was assessed after the educational sessions and 2years later using Kirkpatrick's four-level evaluation model. This study is the first study to use Kirkpatrick model to evaluate an educational programme for dental students. The results of the first level of evaluation showed an overall satisfaction score of 82.1%. The second level revealed an increase in the percentage of correct answers after the educational sessions from 68.3% to 80%, and significant agreement with responsible antibiotics usage (p-value=.020, Effect size=0.121). The third level showed that the percentage of correct answers 2years later was 87.5%. The fourth level confirmed the success of the programme as 88.9% of participants reported using the knowledge gained from the programme when prescribing antibiotics. Our study emphasises the success of the used educational programme and highlights the need for educational interventions in the under graduate dental curriculum.

Prescription Pattern of Antibiotics in Admitted Patients of a Tertiary Care Government Teaching Hospital, Kerala, India

Introduction: Antibiotics have a remarkable role in prolonging life, especially in underdeveloped and developing countries. Insufficient knowledge among doctors, peer pressure and patient demands, diagnostic uncertainties, lack of communication between the doctor, pharmacist and patients all implicate inappropriate antibiotic prescribing practices. Irrational antibiotic prescription can lead to antibiotic resistance, marking a global crisis. Aim: To evaluate the prescription pattern of antibiotics in the admitted patients of a tertiary care teaching hospital and assess the prescriptions' rationality. Materials and Methods: This was a retrospective record-based study done in the inpatients of Government Medical College, Manjeri, Kerala, India, for three months (1st October 2017 to 31st December 2017). Data was collected using a data collection checklist which included patient identity and demographic factors, name and route of the antibiotic prescribed, usage of multiple antibiotics, usage of prophylactic antibiotic, usage of generic names, adherence to National List of Essential Medicines (NLEM) and rational use. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 and frequencies and percentages were determined for each variable. Results: Total 1,186 medical records were analysed, and 49.7% were prescribed antibiotics; 38.2% contained more than one antibiotic, and 64.8% contained parenteral antibiotics. Cefotaxime was found to be the most commonly prescribed antibiotic. An 88.3% of prescriptions were adhering to NLEM, and 29% contained generic names of antibiotics. Overall, 69 out of 589 (11.7%) were irrational prescriptions, and the use of multiple antibiotics with the same spectrum of coverage was found to be the most common reason for irrationality. Conclusion: In this study, the most drugs were prescribed from the NLEM. Cephalosporins were the most commonly used antibiotics for the inpatients in this hospital. Prescriptions with generic names of drugs were low. Irrational prescriptions contributed a minor percentage, and reserve antibiotics were too little.

Prescription Practices of Antifungal Agents at Gynaecology and Oncology Departments of a Tertiary Hospital in Mwanza, Tanzania: A Retrospective Study

Introduction: Irrational antifungals prescription results in inappropriate use of antifungals, leading to emergence of antifungal resistance. Aim: To determine the prescription patterns of antifungal agents in gynaecology and oncology departments of the tertiary hospital in Tanzania. Materials and Methods: This was a retrospective hospital-based study involving files of patients who attended gynaecology and oncology department of Bugando Medical Centre between January 2017 and December 2017. All files of patients with fungal infections were analysed. Checklist was used to collect information such as clinical diagnosis, age, name of antifungal, number of antifungals, dosage form and dose frequency. Descriptive analysis was done using STATA version 13.0. Results: A total of 1,070 files of patients who attended gynaecology and oncology departments in the year 2017 were retrieved, of which 860 (80.4%) were from patients who attended gynaecology department. A total of 156 (14.6%) files out of 1,070 were of patients with fungal infections. Of the patients from gynaecology 116 (n=860, 13.48%) had fungal infection. While of the patients from oncology 40 (n=210, 19.1%) had fungal infection. The most common fungal infection diagnosed were vaginal candidiasis 112 (96.6%) and oral candidiasis 33 (82.5%) from gynaecology and oncology department, respectively. Common antifungal prescribed were azoles (clotrimazole 56.9% in gynaecology and fluconazole 37.5% in oncology). The prevalence of irrational antifungal prescription in gynaecology and oncology departments was 22.4% (26/116) and 20% (8/40), respectively. Conclusion: About one in five antifungal prescriptions for vaginal candidiasis in gynaecology and oral candidiasis in oncology are irrational as evidenced in standard treatment guideline. Clinicians should adhere to the national standard treatment guidelines in order to reduce irrational prescriptions of antifungal agents.