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: