Utilization pattern of antibiotics and drug related problems in the orthopedic department at a tertiary care hospital: a prospective study
Abstract
Background: Antibiotics are generally prescribed for both prophylactically and to treat ongoing infections in the orthopedic department. Assessment of prescribing pattern at regular interval is essential to avoid inappropriate use of drugs.
Objectives: To know the utilization pattern of antibiotics and drug related problems like adverse drug reactions (ADR) and drug-drug interactions (DDI) in hospitalized patients.
Materials and Methods: A cross-sectional study was conducted among hospitalized patients using WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology for one month duration in orthopedic department at a tertiary hospital. Standard data collection forms were used to collect the data. Descriptive statistics were used for analyzing the data.
Results: Out of 196, most of patients (72.96%) were male and most of patients (34.69%) were from the age group 21-30 years. A total of 782 drugs were prescribed during study period and among them 262 were antibiotics. None of the drugs were prescribed in generic name. Ceftriaxone (33.58%) was the most frequently prescribed antibiotic. Average cost of drug therapy per patient was NPR 3125.7. DDD/100 bed-days were highest for Cefixime (27.9). A total of 233 ADRs were suspected in 64 patients (32.6%). Thrombophlebitis (26.2%) was the commonest ADR. Potential DDI were found in 51 patients (26.02%). The most common interacting pairs were Cefuroxime and Rabeprazole (15 encounters).
Conclusion: Generic prescribing is urgently needed for cost minimization. The prevalence rate of ADR occurrence and DDI was high. The study finding benefits the hospital policy makers to formulate and address policies for rational use of antibiotics.
Keywords: Adverse Drug Reactions; Antibiotics; Cost; Drug Utilization; Drug-Drug interaction
Keywords:
Antibiotics, Adverse Drug Reactions, Drug Utilization
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References
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28. Gowthami B, Spurthi T and Afreen S. Drug utilization evaluation of antibiotics in general medicine department of a tertiary care hospital. Int J Pharm Sci. 2016; 8(6): 302-304.
29. Khade AM, M Bashir MS, George S, Annaldesh S and Bansod KA. Prescription pattern of antimicrobial agents in a teaching hospital of South India. Int J basic Clin Pharmacol 2013; 2:567-570.
30. Bozkurt F, Kaya S, Tekin R, Gulsun S, Deveci O, Dayan S et al. Analysis of antimicrobial consumption and cost in a teaching hospital. J Infect Public Health. 2014;7 (2):161-9.
31. Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L. Quantitative antibiotic use in hospitals: comparison of measurements, literature review and recommendations for a standart of reporting. Infection. 2008; 36(6):549-59.
32. DP Sarraf, GP Rauniar, A Misra. Drug utilization pattern in four major wards of a tertiary hospital in eastern Nepal. Health Renaissance. 2015; 13(2):50-65.
33. Aurel O Iuga, Maura J McGuire. Adherence and health care costs. Risk Manag Healthc Policy. 2014; 7:35-44.
34. Kuruvilla A, George K, Rajaratnam A, John KR. Prescription patterns and cost analysis of drugs in a base hospital in South India. Natl Med J India. 1994; 7(4):167-8.
35. Atif M, Azeem M, Sagib A, Scahill S. Investigation of antimicrobial use at tertiary care Hospital in Southern Punjab WHO Methodology. Antimicrobial Resistance and Infection Control. 2017; 6:41.
36. Nia SS, Hiremath SRR, Prasad S. Assessment of Antimicrobial Use Pattern Using World Health Organization Prescribing Indicators at a Tertiary Hospital: A Prospective, Observational study. Journal of Applied Pharmaceutical Science. 2018; 8(6):132-8.
37. LF Caldeira, MN Burattini. Analysis of antimicrobials’ consumption profile in a University Hospital of Western Paraná, Brazil. Brazilian Journal of Pharmaceutical Sciences. 2009; 45(2):295-302.
38. Smita Anand Tiwari, Ghongane Balasaheb Baburao. ATC/DDD Method to Assess the Injectable Antibiotics Utilization in a Tertiary Care Teaching General Hospital in India. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2017; 16(6):39-43.
39. Ramesh M, Pandit J, Parthasarathi G. Adverse drug reactions in a south Indian hospital--their severity and cost involved. Pharmacoepidemiol Drug Saf. 2003; 12(8):687-92.
40. Batta A, Madan N, Kalra BS, Arora S. Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study. MAMC J Med Sci. 2019; 5(2):77-82.
2. Le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM. Intervention research in rational use of drugs: a review. Health Policy and Planning. 1999;14(2):89-102.
3. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009; 373(9659):240-9.
4. Sellers JA. Medicare drug benefit. American Journal of Health-System Pharmacy. 1999; 56(15):1503.
5. Wettermark B, Vlahovic-Palcevski V, Salvesen Blix H, Ronning M, Vander Stichele RH. Drug utilization research. In: Hartzema AG, Tilson HH, Chan KA, eds. Pharmacoepidemiology and Therapeutic Risk Management. Cincinnati, OH, Harvey Whitney Books, 2008.
6. World Health Organization. Introduction to drug utilization research. Oslo: 2003.
7. Ahmed Md, Ali N, Rahman UZ, Khan M. A Study on prescribing pattern in the management of arthritis in the department of Orthopedics. Scholars Research Library. 2012;4(1)5-27.
8. Jayanthi MK, Sushma NV (2014). Drug utilization pattern and pharmacoeconomic study in paediatric dentistry at a tertiary hospital. Int J Pharm Pharm Sci; 6 (2): 70-72.).
9. Suman RK, Deshmukh YA, Ray I, Gore VS. Drug utilization studies in glaucoma patients at MGM Medical College and Hospital. Int J Sci Res. 2013; 7(2):433-435.
10. Abhijit K, Jain P, Upadhyaya P, Jain S. Antibiotic prescribing in various clinical departments in a tertiary care teaching hospital in northern India. J Clin Diagn Res. 2014; 8(5):HC09-11.
11. Abula T, Kedir M. The pattern of antibiotic usage in surgical in-patients of a teaching hospital, northwest Ethiopia. Ethiopian Journal of Health Development. 2004;18(1):9863.
12. Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci USA. 1999;96(3):1152-6.
13. Hosoglu S, Esen S, Ozturk R. The effect of a restriction policy on the antimicrobial consumption in Turkey: a country-wide study. Eur J Clin Pharmacol 2005, 61(10):727-31.
14. World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva, 1993.
15. Pharmacovigilance. Department of Drug Administration, Ministry of Health and Population, Government of Nepal, Kathmandu, 2018. [Available at http://www.dda.gov.np/content/pharmacovigilance]
16. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2):239-45.
17. Drug interaction checker. Medscape, 2016. [Available at https://reference.medscape.com/drug-interactionchecker]
18. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo, 2016. [Available at https://www.whocc.no/filearchive/publications/1_2013guidelines.pdf]
19. Choudhury DK, Bezbaruah BK. Prescribing pattern of analgesics in orthopedic in-patient department at tertiary care hospital in Guwahati, Assam, Northeast India. Indian J Pharmacol. 2016;48(4):377-81.
20. Das SK, Kurra V, Guttu P, A Quadri, Chowdary TN, B Valya et al. Antibiotic and Analgesic utilization review in an orthopedics in-patient department of a tertiary care teaching hospital in Hyderabad. Int J Pharm. 2016; 6(3):1-79.
21. Abhilash S, Rashmi R Rao, Sivaguha Yadunath. Assessment of prescribing pattern among orthopedic in-patients using who prescribing indicators. Asian J Pharm Clin Res. 2018; 11(12):505-9.
22. Bithi SS, Khan Rahman Minnazur MD, Khan AU. Drug utilization study in orthopaedic units: Antibiotics prescribed in hospital out-patients in Dhaka, Bangladesh. International Current Pharmaceutical Journal. 2014; 3(9):318-21.
23. Kumar GA, Kumar DC, Ajay K, Madhumita R. Drug utilization study on antibiotics use in an orthopaedics department of a tertiary care hospital in west Bengal. Journal of drug delivery and therapeutics. 2013; 3(2):98-103.
24. Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari RB et al. A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal. Kathmandu Univ Med J (KUMJ). 2006; 4(4):436-43.
25. Aswapokee N, Vaithayapichet S, Heller RF. Pattern of antibiotic use in medical wards of a university hospital, Bangkok, Thailand. Review Infect Dis. 1990; 12(1):136-41.
26. Promoting rational use of medicines: core components. WHO policy perspectives on medicines, WHO, 2016, Geneva. [Available at http://apps.who.int/medicinedocs/en/d/Jh3011e/]
27. Ray D, Datta S. A study on antimicrobial agents utilization pattern using anatomical therapeutic chemical/daily defined dose system and adverse drug reaction pattern in the intensive care unit of a tertiary care teaching hospital in North Eastern state of India. Int J Basic Clin Pharmacol 2018; 7:1612-9.
28. Gowthami B, Spurthi T and Afreen S. Drug utilization evaluation of antibiotics in general medicine department of a tertiary care hospital. Int J Pharm Sci. 2016; 8(6): 302-304.
29. Khade AM, M Bashir MS, George S, Annaldesh S and Bansod KA. Prescription pattern of antimicrobial agents in a teaching hospital of South India. Int J basic Clin Pharmacol 2013; 2:567-570.
30. Bozkurt F, Kaya S, Tekin R, Gulsun S, Deveci O, Dayan S et al. Analysis of antimicrobial consumption and cost in a teaching hospital. J Infect Public Health. 2014;7 (2):161-9.
31. Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L. Quantitative antibiotic use in hospitals: comparison of measurements, literature review and recommendations for a standart of reporting. Infection. 2008; 36(6):549-59.
32. DP Sarraf, GP Rauniar, A Misra. Drug utilization pattern in four major wards of a tertiary hospital in eastern Nepal. Health Renaissance. 2015; 13(2):50-65.
33. Aurel O Iuga, Maura J McGuire. Adherence and health care costs. Risk Manag Healthc Policy. 2014; 7:35-44.
34. Kuruvilla A, George K, Rajaratnam A, John KR. Prescription patterns and cost analysis of drugs in a base hospital in South India. Natl Med J India. 1994; 7(4):167-8.
35. Atif M, Azeem M, Sagib A, Scahill S. Investigation of antimicrobial use at tertiary care Hospital in Southern Punjab WHO Methodology. Antimicrobial Resistance and Infection Control. 2017; 6:41.
36. Nia SS, Hiremath SRR, Prasad S. Assessment of Antimicrobial Use Pattern Using World Health Organization Prescribing Indicators at a Tertiary Hospital: A Prospective, Observational study. Journal of Applied Pharmaceutical Science. 2018; 8(6):132-8.
37. LF Caldeira, MN Burattini. Analysis of antimicrobials’ consumption profile in a University Hospital of Western Paraná, Brazil. Brazilian Journal of Pharmaceutical Sciences. 2009; 45(2):295-302.
38. Smita Anand Tiwari, Ghongane Balasaheb Baburao. ATC/DDD Method to Assess the Injectable Antibiotics Utilization in a Tertiary Care Teaching General Hospital in India. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2017; 16(6):39-43.
39. Ramesh M, Pandit J, Parthasarathi G. Adverse drug reactions in a south Indian hospital--their severity and cost involved. Pharmacoepidemiol Drug Saf. 2003; 12(8):687-92.
40. Batta A, Madan N, Kalra BS, Arora S. Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study. MAMC J Med Sci. 2019; 5(2):77-82.
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Yadav D, Alam K, Sah A, Sarraf D. Utilization pattern of antibiotics and drug related problems in the orthopedic department at a tertiary care hospital: a prospective study. JDDT [Internet]. 15May2020 [cited 25Apr.2024];10(3):24-0. Available from: https://jddtonline.info/index.php/jddt/article/view/4056
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