Evaluation of the status of antibiotic prescription in patients admitted to a teaching hospital in west of Iran
DOI:
https://doi.org/10.22122/cdj.v5i1.229Keywords:
Antibiotic, Prescription, PatientsAbstract
BACKGROUND: The aim of this study was to evaluate the status of the appropriate use of antibiotics by type, dosage, and length of treatment and the route of administration in Tohid teaching hospital, Sanandaj, Iran.
METHODS: In a retrospective descriptive study, 400 patients were systematically selected from patients receiving antibiotics hospitalized in Tohid hospital from March 2016 to March 2017. Demographic characteristics, hospitalization ward, diagnosis, antibiotic prescribed, dosage, length of treatment, the route of administration, and prescribing physician were recorded. The treatments were compared with standard treatment based on Harrison reference. The data were analyzed using STATA software.
RESULTS: Out of total patients, 54% were men and 46% were women with a mean age of 57.87 ± 9.87 years. The mean duration of hospitalization was 6.37 ± 2.69 days. More and less numbers of patients were admitted in the internal medicine ward (23.75%) and intensive care unit (ICU) (1.00%), respectively, The highest antibiotics were administered by internal medicine specialists (40.25%), the most commonly prescribed antibiotic was ceftriaxone (34.59%), and the most common cause of antibiotic therapy was pneumonia (20.50%). Out of 595 antibiotics prescribed, 28.50% of the administrations were inappropriate. In addition, the objective for the prescription of the first and second antibiotic was inappropriate in 27.50% and 33.70% of cases, respectively. Dosage, route of administration, and the length of treatment of the prescribed antibiotic was inappropriate in 9.00%, 0.50%, and 41.00% of cases, respectively. The highest and lowest rate of inappropriate antibiotic prescription was observed in surgical (51.31%) and infectious diseases (12.90%) wards.
CONCLUSION: Due to the increase inappropriate administration of antibiotics, it is necessary to train the specialists about the planning, appropriate medical consultations for antibiotic therapy, and limitation of the new antibiotics prescription.
References
Katzung BG, Trevor AJ. Basic and clinical pharmacology. New York, NY: McGraw Hill Professional; 2014. p. 789.
Raveh D, Levy Y, Schlesinger Y, Greenberg A, Rudensky B, Yinnon AM. Longitudinal surveillance of antibiotic use in the hospital. QJM 2001; 94(3): 141-52.
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017; 2: CD003543.
Gendel I, Azzam ZS, Braun E, Levy Y, Krivoy N. Antibiotic utilization prevalence: Prospective comparison between two medical departments in a tertiary care university hospital. Pharmacoepidemiol Drug Saf 2004; 13(10): 735-9.
Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H. Rational antibiotic use. J Infect Dev Ctries 2009; 3(2): 88-93.
Amane H, Kop P. Prescription analysis to evaluate rational use of antimicrobials. Int J Pharm Bio Sci 2011; 2(2): 314-9.
Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Keuter M, Huis Int V, et al. Audit of antibiotic prescribing in two governmental teaching hospitals in Indonesia. Clin Microbiol Infect 2008; 14(7): 698-707.
Hatam N, Askarian M, Moravveji AR, Assadian O. Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran. Iran Red Crescent Med J 2011; 13(4): 234-8.
Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res 2011; 134: 281-94.
Baktygul K, Marat B, Ashirali Z, Harun-Or-rashid M, Sakamoto J. An assessment of antibiotics prescribed at the secondary health-care level in the Kyrgyz Republic. Nagoya J Med Sci 2011; 73(3-4): 157-68.
Gangwar AS, Kumar N, Kothiyal P. Antibiotic prescription and cost patterns in an intensive care unit: A review of literature. Pharm Innov 2012; 1(7): 68-72.
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill Education; 2015
Rajalingam B, Alex AS, Godwin A, Cherian C, Cyriac C. Assessment of rational use of antibiotics in a private tertiary care teaching hospital. Indian Journal of Pharmacy Practice 2016; 9(1): 14-8.
Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136(5): 1237-48.
Gavilanes Sanchez T, da Silva N, Oliveira H, Karnikowski M, de Oliveira Karnikowski M. Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit. Health 2014; 6(2): 188-94.
Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: Current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003; 163(8): 972-8.
Alavi Moghaddam M, Yadegarinia D, Zamiri SA. Pattern of empiric antibiotic prescription in patients referred to an emergency department of a Medical University affiliated hospital in Tehran. Pejouhandeh 2009; 14(1): 31-6. [In Persian].
Ayuthya SK, Matangkasombut OP, Sirinavin S, Malathum K, Sathapatayavongs B. Utilization of restricted antibiotics in a university hospital in Thailand. Southeast Asian J Trop Med Public Health 2003; 34(1): 179-86.
Maki DG, Schuna AA. A study of antimicrobial misuse in a university hospital. Am J Med Sci 1978; 275(3): 271-82.
Ceyhan M, Yildirim I, Ecevit C, Aydogan A, Ornek A, Salman N, et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey. Int J Infect Dis 2010; 14(1): e55-61.
Mettler J, Simcock M, Sendi P, Widmer AF, Bingisser R, Battegay M, et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: A prospective observational study. BMC Infect Dis 2007; 7: 21.