ANTIMICROBIAL UTILIZATION PATTERN IN A TEACHING DISTRICT HOSPITAL OF NEPAL

Abstract

The objective of this study was to monitor the antimicrobial utilization in a teaching district hospital and to
compare it against the rational antimicrobial use guidelines.
Total 106 data sheet of indoor patients admitted in year 2001 were randomly chosen and analyzed. The
number of antimicrobials prescribed in every prescription was taken into account to calculate the incidence
of use of more than one antimicrobial agent. The Patient sheet included patient information, drug information
(name, indication, dose, frequency and duration of antimicrobial use), diagnosis or provisional diagnosis
and investigations. Prescription auditing was done on the selected prescriptions.
Male: female ratio was 40:65. In 90.57% diagnosis was established empirically and in only 4.7 % patients
confirmatory diagnosis was made using relevant investigations. The antimicrobials were prescribed chiefly
for respiratory tract infections (RTI -26.41%), gastrointestinal infections (GIT -22.64%), genital tract
infection (13.20%), wound infections (8.48%), urinary tract infections (UTI-6.6%), bone & joint infections
(4.71%) and miscellaneous (Typhoid, Malaria, meningitis etc-17.92%). The causative organism was
confirmed using culture & sensitivity tests in only one patient (0.94%) out of 106 patients. In 77 (69.8%)
patient prescriptions suspected pathogenic organisms were mentioned. These were streptococcus (29.58%),
Chlamydia (11.27%), mycoplasma (18.30%), staphylococcus (23.94%), E. coli (32.39%) and S. typhi
(15.49%). In 35 prescriptions (33.01) no causative organism was mentioned. It was further observed that a
total 452 drugs (i.e. 4.26 drugs per patient), out of this only 165 antimicrobials (1.55 antimicrobials per
patient) were prescribed in the 106 enrolled prescriptions. On further analysis of antimicrobials use, it was
observed that most patients were prescribed a single antimicrobial agent (58.49%), two AMAs (24.52%),
three AMAs (13.20%) and least was four AMAs (3.77%).The antimicrobials were given prophylactically
in 14 (13.10%) and therapeutically in 85 (80.18%) prescriptions. The use of antimicrobials were not indicated
in 7(6.60%) prescriptions.. In 91 cases (85.85%) duration for which AMAs were considered was not
mentioned. Ampicillin + cloxacillin (12.12%), ciprofloxacin (10.30%), metronidazole (10.30%), amoxycillin
(10.30%) and cephalosporins (25.47%) were the most frequently prescribed AMAs. A fixed dose combination
of ampicillin & cloxacillin, ciprofloxacin and metronidazole were recurrently prescribed while gentamicin,
cotrimoxazole and crystalline penicillin were relatively least prescribed antimicrobials agents.
Inappropriate and irrationality in the Antimicrobial prescribing pattern was observed.
Das B P*, Sethi A*, Rauniar G P*
Key Words: Antimicrobial agent, Respiratory tract infection (RTI), urinary tract infection (UTI),
gastrointestinal infection, prophylaxis, therapeutic.