ABSTRACT
Objectives: The leading purpose of this investigation is to
measure the excellence of drug treatment by likeable in the assessment
of data on drug prescribing, dispensing, administering and use of drugs
by patient.
Material & Methods: The study was planned to be a
retrospective, assessing the prescribing design concerned about the
utilization of anti-biotic in the management of various infections,
throughout a period of two months January 2017 to February 2017
(approximately 60 days). The study was done at tertiary care hospital in
which the prescriptions of 200 patients from the medical wards, were
evaluated, in which 57 (28.5%) were females and 143 (71.5%) were
males. Data analysis was carried out using Microsoft Excel.
Results: Mostly prescribed antibiotic were ceftriaxone 105
(34.09%), amoxicillin/clavulanic acid 18 (5.84%), moxifloxacin 35
(11.36%), metronidazole 55 (17.85%), azithromycin 7 (2.27%),
sulbactam/cefoperazone 22 (7.14%), doxycycline 13 (4.22%),
ciprofloxacin 40 (12.98%), cefotaxime 5 (1.62%), and clarithromycin 3
(0.97%). Total number of drugs prescribed were 1643 in which the
average number of drugs encountered per prescription were 8.21, the
percentage of encounters with antibiotics were 308 (18.74%), the
percentage of encounter with injections were 897 (54.59%), the
percentage of drugs prescribed by generic name were 205 (12.47%), and
the percentage of drugs prescribed from EDL were 1367 (83.20%).
Conclusion: On the bases of our study, the pattern used at this
Hospital for the, prescription of antibiotics, injections, generic
concept and drugs from EDL shows deviation from the standards guidelines
of WHO.
Key Words : Antibiotics, Assessment, Prescription, Poly-pharmacy
Introduction:
Prescription is a written paper which contain medication prescribed to a
patient by a prescriber and it is an authorized concern of not
individually of the physician but of all those which are involves in the
implementation of the prescription. Prescriptions writing needs
significant and basic skills of a physician, so specific supervision and
working out in prescription writing must be done during undergraduate
and postgraduate teaching to minimize the error in prescription
writing.1
Antibiotics are drugs utilized for treating diseases brought about by
bacteria, and they have saved endless lives.23Antibiotics are as of now the most regularly prescribed drugs in medical
clinics globally.24,25 However, the unseemly
utilization of antibiotics adds to the improvement of bacterial
resistance, which quickens the rise and spread of resistant
microorganisms and significantly affects the therapy result. Antibiotic
resistance (ABR) creates when conceivably unsafe microscopic organisms
change in a manner that lessens or wipes out the viability of the
antibiotic. In spite of the fact that ABR is a typical issue, the wrong
use and malprescribing of antibiotics are expanding the frequency of
ABR.26 ABR has been identified globally; it is
probably the best test to worldwide general wellbeing today and the
issue is growing.25 The inexorably fast development and spread of ABR
has become an overall issue during the previous few
decades.23,27,28
Presently, the CDC cautions wellbeing experts to work in improving
antibiotic prescribing practice and use in human medical care, and
suggests the foundation of an ASP.29 Changing
recommending practices could be troublesome, however there are
demonstrated, proof based techniques to advance antibiotic treatment for
people while limiting damage to the patient and lessening ABR in the
community. Thus, the rational use of antibiotics is a significant
wellbeing need 24. There is no uncertainty that
antibiotics have crucial roles in medical care frameworks globally and
they are fundamental in all medical services settings. Despite the fact
that antibiotics are a foundation instrument in medical care conveyance
in emergency clinics and save incalculable lives, up to half (20–50%)
of prescribed antibiotics are improperly burned-through,
globally.30 This substantially affects the nature of
the medical services framework and remedial expenses, and builds the
pace of unfavorable medication events.24
Wrong utilization of antibiotics agents is predominant, resulting in
ABR, which is a key challenge in community. Wrong utilization of these
medications could be unsafe and lead to ABR.28,31Patients with antibiotic-resistant infections are bound to encounter
ineffectual treatment, repetitive contamination, death or delayed
recovery.31,32 About 6.5% of morbidity and mortality
of hospital admissions is linked to unsuitable prescribing of
antibiotics, even though maximum of these actions are
avoidable.16
The most common method used for the treatment of a disease is medication
therapy in general medical practice. However, the patterns of drug
prescription are often irrational and actions for these patterns are
essential to recover prescribing standards.2
Drug utilization studies (DUSs) is defined as an organized process that
is used to evaluate the quality of drug therapy by compelling in the
assessment of data on medication prescribing, dispensing, administering
and use of drugs by patient in a given health care setup, against
specific standards guidelines. Drug utilization educations pursue to
supervise, assess and suggest alterations in the prescribed medication
with the purpose of making the pharmaceutical care rational and
economic.3
It also cooperates and develops working association with other health
team to accomplish a rational utilization of drugs. Prescription
patterns define the scope and profile of drug utilization, patterns,
quality of drugs, and consistence with territorial, public and
international guidelines like WHO standards, utilization of drugs from
essential list of drugs and use of generic drugs.
Antibiotics are the significant medications for treatment infections and
are the supreme commonly recommended drugs in medical as well as in
surgery departments.4 Resistance to antibiotics can be
initiated by various factors such as health facilities, medication
non-compliance, various prescribers and dispensers, use of first
generation medications, unsuitable medication usage, consumption of
wrong dosage, inappropriate usage of drugs, use of counterfeit drugs,
over and under usage of medications.5
Irrational medication use can also lead to augmented effects and patient
death can occur due to irrational use of drugs.6Peoples living in the developing world often develop resistance to
antibiotics which is one of the reasons for poor treatment outcomes and
higher healthcare use.7 Irrational prescribing make
drug use further difficult.
Many studies in both develop and developing countries, defines it as a
pattern containing poly-pharmacy, use of medicines that are not
accompanying to the treatment or unnecessary costly use of drugs,
irrational use of antibiotics, and self -medication, and taking drugs in
not enough quantities.8 In clinical practice, the
irrational prescribing design has been extensively reported from both
developing as well as developed nations. The danger brought about via
indiscreet utilization of antibiotics can be streamlined by
accomplishing proper utilization of antibiotics.9
A study was carried out in primary health care hospitals on
prescription, which was written by several doctors and was mainly
stressing on primary health care centers and dispensaries. Data were
collected in one year duration from March 2006 to February 2007. Data
was collected on the basis of WHO standards. Standardized WHO tools were
used for evaluation of appropriate medicine usage. The results of the
study were such that the average number of drugs per encounter was 6.11,
while the percentage of drugs prescribed by generic names were 69.81%,
the percentage of antibiotics prescribed was 50.10%, while the
percentage of injections prescribed was 72.70% and about ninety four
percent (94%) of drugs were prescribed from EDL. The use of antibiotics
and injections was very high from the standards of
WHO.10
Another study was carried out in geriatric patients whose age was more
than 60 years and was prescribed in the tertiary care hospital. The
demographic data and data on prescribing pattern were evaluated in case
sheets. Three hundred-six (306) prescriptions were collected from
different outpatient departments in which 102 (33.3%) were females and
204 (66.6%) were males. A total of 1749 medicines was prescribed, in
which the 5.7 drugs per prescription was average drugs. The drugs
prescribed by their generic names were 315 (18.01%), the percentage of
antibiotics prescribed as single or in combination were 128 (41.8%),
and the percentage of injections prescribed were 138 (45.1%) of the
prescriptions, and about 35% of the drugs were prescribed from the
NEDL.11
Improper utilization of antibiotics is a great community health concern
in light of its expanded odds of improvement of antibiotic resistance to
numerous antibiotics in a community. Prescriptions monitoring can
recognize the problems associated to prescriptions and provide feedback
to the prescriber so as to produce awareness for the rational use of
drugs.12
An examination was done for one month duration in April- May 2011. The
details of the patients were being documented in a detailed format and
results were evaluated by descriptive statistic and expressed as mean ±
SD. The results of the study was such that, the total number of patients
were 200, among these 132 patients were received antibiotics, in which
77 (58.33%) was male and 55 (41.66%) was female. An antibiotic per
prescription was 1.41 ± 0.67. The duration of antibiotic therapy was
6.05 ± 3.45 days and length of hospitalization was 8.91 ± 5.35. In our
study, 71% of child patients were on single antibiotic and most of the
child patients were receiving injectable preparation. The most generally
used antibiotic in the study were Cephalosporin (41.5%), and most
commonly found antibiotics combination in the study were & Cefotaxime,
Clavulanic acid, Sulbactam and Amoxicillin.4
Another study was carried out at Hawassa university teaching and
referral hospital. The total number of drugs prescribed was 491 with
average number of 1.9 in the range of 1-4 drugs were prescribed per
encounter. The percentage of antibiotics was 58.1% per prescription,
the percentage of injection was 38.1%. The Percentage of medicines
prescribed by generic name was 98.7% and percentage of medicines
prescribed from EDL was 96.6%. Among the antibiotics most generally
used antibiotics were ampicillin (15%), amoxicillin (16.4%),
cloxacillin (13.4%), gentamicin (14.9%), ceftriaxone (9.8%) and
chloramphenicol (11.6%).13
For the appropriate use of antibiotics and to reduce the bacterial
resistance an improvement in antibiotic prescribing pattern is needed
and control hospital costs is a rising importance, in any case, the best
approach to achieve this is inadequately characterized. Suitable
medication use has an immense commitment to worldwide decreases in
mortality and morbidity with its resultant clinical, social and monetary
administrations.14 The effective medication classes of
antibiotics must be listed in EDL and among these classes the most
suitable antibiotic must be selected from the theme of its
effectiveness, safety, suitability and cost effectiveness of the
drugs.15
Nowadays antibiotics are the broadly utilized class of drugs around the
globe. As per the WHO report, the unseemly utilization of antibiotics
was 50% while the overuse and misuse was up to 100% in URTIs a study
was carried out on the use of antibiotics in 13 low, middle and high
income countries during 1993-1996, the study presents that approximately
30% cases of UTIs were inaccurately prescribed for
antibiotics.16 Because of high level of community
antimicrobial drug resistance the use of costly drugs becomes compulsory
which may not be economical for majority of population in developing
countries like India.17
Thus, understanding the prescribing pattern of antibiotics is a main
initial step for the foundation of ASPs in such asset restricted
locations. Consequently, this examination expected to explore endorsing
examples of antibiotics and distinguish the most often prescribed
antibiotics for hospitalized patients. Furthermore, this work will add
proof for policymakers to plan procedures and apply mediations to
upgrade the reasonable endorsing of antibiotics among hospitalized
patients in Pakistan and all the more all around the world. When the
prescribing pattern of antibiotics has been resolved, suitable systems
can coordinate the ASP toward mediations that must be made to improve
the proper prescribing practice of antibiotics agents for hospitalized
patients. It could likewise be useful as a record for different
scientists who are interested on this territory.
Methodology: