Assessment of Antibiotic Prescribing Pattern in Paediatric Department: An Observational Hospital Based Study

Background: Frequent irrational use of antibiotics has merged out to antimicrobial resistance to a significant proportion globally, which has led to momentous mortality, morbidity and healthcare costs. To overcome this issue there is a need to inculcate institutional protocols based on rational standard guidelines (WHO). Aim: To evaluate the quality of prescribing pattern of antibiotics by health care providers and to find out other associated factors in the inpatient department of paediatrics at a tertiary care teaching hospital. Methods: An observational and prospective study was carried out in a tertiary care teaching hospital in Coimbatore, India. A total number of selective 200 paediatric inpatients were included in the given study for a period of six months. Patient’s demographics were recorded in a prestructured and validated data collection form. These data were then analysed for various drug use parameters using indicators based on standard protocol. Results: Around 3.02 drugs were prescribed per encounter which was higher as per WHO standard which is 2.0. The present study shows that the encounters with antibiotics was 57% (n=114), which were also relatively higher than the standards. Among 200 antibiotic prescriptions, 22.5% of the drugs were prescribed using generic names and 96.9% of the drugs were prescribed as per the essential drug formulary list. Respiratory infections (21%) and gastrointestinal infections (18%) were the most common diagnoses. Cephalosporins (38.96%) were the most frequently used antibiotic in our study. Conclusion: As per the WHO guidelines, standard surveillance system is required in all hospital setups at all levels. Effective interventions are required to reduce inappropriate antibiotic prescriptions. Ebin Siby*, B. Chitra, Anjali S. Nair Doctor of Pharmacy (Pharm.D), Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore-44 Affiliated to The Tamil Nadu Dr.M. G.R. Medical University Submission: 23 September 2019 Accepted: 29 September 2019 Published: 30 October 2019 www.ijppr. humanjournals.com Citation: Ebin Siby et al. Ijppr.Human, 2019; Vol. 16 (3): 165-174. 166 INTRODUCTION Antibiotics were found to be the most prevalent drugs prescribed for children. Antibiotics are double edged sword and can give rise to antimicrobial resistance if used injudiciously and may endanger many patient’s lives. Irrational overuse of antibiotic medications have been noted in both developed and developing countries with around 50-85% of them receiving antibiotics. All together about 29% of the children and infants due to immature immune system are mainly susceptible to infections worldwide. Initial moonlight on first antimicrobial resistance was noted during 1948 and today each known pathogen have become resistant to one or more antimicrobials. Arguably the greatest impact of antimicrobial resistance was noted in low income countries due to high rates of infections and fewer choices of antibiotics. Indiscriminate and irrational drug use have become a biological global threat. Need for newer antimicrobial are in great demand as even the reserved category of drugs are also been used in high proportion due to increased resistance to the previous line of drugs. The circumstances have emerged due to limited data availability on profiles of antibiotic usage and proper selection of antibiotics and non-standardised indications for individual antibiotic. There is an increasing need to involve implementation of parent education, public awareness creation and sensitisation of health care professionals as a part of antimicrobial resistance control measures. A proper multi-disciplinary approach through proper navigation will be useful to overcome the present threats of antimicrobial resistance around the globe. The rationality of prescribing pattern is also one of the important factor to be kept under surveillance as improper prescribing habits such as overuse, underuse and misuse can lead to health hazards, unsafe treatments, exacerbation of infections leading to increased economic burden on the patients. The following factors gives a clear portrait on irrational use such as polypharmacy, use of antimicrobials even in non-bacterial infections, inadequate dose or course, self medications and non-compliance to dosage regimen. To combat this global challenges rational prescribing pattern should be revolutionised. But unfortunately, uptake of this concepts has been very slow, as only fewer countries have developed a good antimicrobial stewardship promoting policies. One such antimicrobial stewardship has been developed by the WHO in the form of indicators to detect barriers in prescribing. These indicators are commonly used as standards in drug utilisation studies www.ijppr. humanjournals.com Citation: Ebin Siby et al. Ijppr.Human, 2019; Vol. 16 (3): 165-174. 167 and serve as a platform to measure the performance of the health care providers at primary levels in prescribing antibiotics. The purpose of this study was to evaluate the quality of prescribed paediatric antibiotics by continuous monitoring of prescriptions by analysing a selected category of children by comparing with standard indicators at the population level. MATERIALS AND METHODS: a) Study area and study period: An observational and prospective study was carried out at a tertiary care teaching hospital, India for a period of six months. The institutional ethics committee approval (Ref: SRH/EC.11-16/2017-18) was obtained to conduct the study.