Analysis of prescription pattern of antibiotics among patients with respiratory tract infections at a tertiary care hospital
Authors: Nirmal Kumar Rajaseger , Selva Dr. Preetha 
Published: October 2019

Respiratory tract infections are very common in developing countries like India. The main objective of the present study is to analyze prescription pattern of antibiotics given to outpatients with respiratory tract infections visiting our Hospital and to assess the rationality of these prescriptions given, using World Health Organisation core drug prescribing indicators. A total of 423 prescriptions were analysed after screening for inclusion and exclusion criteria. The number of males were 271 (64%) and females 152 (36%). 232 (54.84%) patients belonged to >60 years age group. Among the various respiratory tract infections, 148 patients (34.98%) were diagnosed to have Chronic Obstructive Pulmonary Disease (COPD), 141 patients (33.33%) Pulmonary Tuberculosis, 71 patients (16.78%) Bronchial Asthma, 34 patients (8.03%) Pneumonia and 29 patients (6.85%) had Upper Respiratory Tract Infections (URTIs). The total number of drugs prescribed were 2368 out of which 447 (18.87%) were mucolytics/expectorants, 433 (18.28%) antibiotics, 350 (14.78%) bronchodilators, 332 (14.02%) corticosteroids, 295 (12.45%) Antitubercular Treatment Category (ATT CAT) drugs, 209 (8.82%) antacids, 112 (4.72 %) anti histamines, 98 ( 4.13%) vitamin tablets, and 92 (3.88) miscellaneous drugs. The most commonly used mucolytic/ expectorant was a fixed dose combination of acebrophylline+ acetylcysteine (327). The most common corticosteroid prescribed was Prednisolone (217). The antibiotics that were commonly prescribed were azithromycin (122), doxycycline (84), ciprofloxacin (82), cefpodoxime + clavulanic acid (61), ceftriaxone (32), amoxicillin + clavulanic acid (27) and piperacillin+ tazobactam (8). Ranitidine (184), levocetrizine (68) or fexofenadine (36), vitamin b complex (79) were the most commonly prescribed antacid, antihistamine and vitamin tablet respectively. The drug formulations prescribed were oral 1842 (77.78%) , inhalations 375 (15.83%), injections 55 (2.32%), syrup 37 (1.56%), gel 36 (1.52%), powder 23 (0.97%). An average of 5.59 drugs was prescribed per prescription. Percentage of drugs prescribed by generic name was 456 (19.3%). Percentage of encounter with antibiotics prescribed was 94%. Percentage of encounters with injection was 9.25%. Percentage of drugs from NLEM was 40.09%. Percentage of fixed dose combinations prescribed were 13.38% . In our study it is observed that more number of drugs can be prescribed from National List of Essential Medicines. Prescription of drugs by generic name also needs improvement. Since the study is done on outpatient setting , culture and sensitivity reports might not be readily available. So choosing an antibiotic might be a dilemma for the physician. There is hence a need for educational programmes in order to facilitate rational use of antibiotics and promote sensible use of available resources. Every hospital should also follow standard treatment guidelines taking into consideration the sensitivity pattern of the organisms in the locality to promote rational prescribing. This study serves to spotlight the current prescribing trends in patients with respiratory tract infectons visiting our hospital.