Drug utilization evaluation is an effective tool for detecting the possible drug related problems and in enhance the clinical use of drugs in public and its impact on the health care system. This tool is adapted by pharmacists to assess appropriate use of medication. DUE usually focus on drugs with more side-effects, high cost or complex dosing regimens. It is important for almost all drugs especially for antibiotics because of its increased utilizationin hospitals and community settings. In prior to starting antimicrobial therapy, the prescriber should consider the type of infection, characteristics of the antibiotic, its category of use, spectrum of activity, cost- effectiveness and duration of therapy. The evolution of multidrug resistance and the emergence of multidrug- resistant microbes are on the rise which can be reduced by increasing the habits of appropriate antibiotic prescribing for the successful outcome of the therapy. Prescribing an antibiotic by understanding the significance of antimicrobial stewardship and following an appropriate guideline may lead to appropriate selection of an antibiotic. Hence, antibiotic utilization studies can help in improving the practice of rational use of antibiotics thereby improving patient safety, which in turn helps in reducing antimicrobial resistance, drug related problems and risk of mortality and morbidity.
Approximately 2–3% of hospitalized patients are known to experience an adverse drug reaction (ADR). Dermatologic ADRs account for 10–30% of ADRs, and are commonly reported to be associated with antibiotic use. The classes of antibiotics most commonly reported to cause cutaneous reactions are the penicillins, cephalosporins, and fluoroquinolones. Polymyxin E is known to cause such reactions, but rarely. Here, we report a case of a colistin- induced maculopapular rash in an 84-year-old male. To the best of our knowledge, this is the first case of colistin-induced maculopapular rash to be reported in India.
Introduction: Studies on the appropriateness of antibiotic use among surgical patients are limited in developing countries, notably in India. Therefore, we aimed to evaluate the inappropriateness of antibiotic use, demonstrate the impact of clinical pharmacist interventions and determine the predictors of inappropriate use of antibiotics in the surgical units of a South Indian tertiary care hospital. Methods: This was a 1-year prospective interventional study on in-patients of the surgical wards to determine the appropriateness of the prescribed antibiotics by reviewing medical records using available antimicrobial susceptibility test reports and medical evidence. When inappropriateness in antibiotic prescriptions was identified, the clinical pharmacist discussed and conveyed apt suggestions to the Surgeon. Bivariate logistic regression analysis was applied to evaluate its predictors. Results: Among the 660 antibiotic prescriptions of 614 patients that were followed and reviewed, about 64% were inappropriate. Most inappropriate prescriptions were witnessed in the cases that involved the gastrointestinal system (28.03%). Among the inappropriate cases, 35.29% were attributed to an excessive regimen of antibiotic use which marked the highest. Based on the category of use, most of the antibiotics were used inappropriately as prophylaxis (76.7%) followed by empirical (71.31%). The increase in the percentage of the appropriate use of antibiotics resulting from pharmacist intervention was 95.06%. There was a significant link between inappropriate antibiotic use and the presence of two or three comorbid conditions, the use of two antibiotics, and length of hospital stay of 6-10 days and 16-20 days (p < 0.05). Conclusions: An antibiotic stewardship program in which the Clinical pharmacist is an integral part along with well-framed institutional antibiotic guidelines must be implemented to assure appropriate antibiotic use.
Medication-related hospital admissions have gained attention during the last few decades. It has been reported that up to 5% of all hospital admissions were medication-related and 50 % of those were avoidable. In India, studies on medication-related hospital admissions are still in the infancy stage. The objective of the study was to assess the types and outcomes of medication-related hospital admissions (MRHA) in a tertiary care teaching hospital. This prospective observational study was conducted for six months at JSS Hospital, Mysuru. Patients of any age and gender, who were admitted to General Medicine, Emergency, Nephrology, Psychiatry, Pulmonology wards due to medication-related problems were enrolled in the study after obtaining an Inform Consent Form. All the necessary data about MRPs were collected and documented in a suitably designed data collection form. MRPs were classified by using Hepler and Strand classification, and the implicated drugs were coded by using the Anatomical Therapeutic Chemical Classification system (ATC) code. Prevalence of medication-related admissions was calculated by dividing the total number of medication-related admissions and the total number of admissions to the hospital. There were 185 MRHA during the study period in the respective departments. The total prevalence of MRHA in the included departments was 1.27%. Failure to receive drugs (50.27%) accounted for the maximum MRHA, followed by adverse drug reactions (46.44 %) and overdose (3.27%). The average cost associated with MRHA was found as INR 10,440 (USD-174, £ - 149). The average length of stay of MRHA was found as approximately seven days [6.96, (sd±2.42)]. The study shows that failure to receive drugs leading to hospitalization are frequent and constitute a significant economic burden. Training of patients and prescribers may lead to a reduction in hospitalization due to MRPs and thus lessen their financial burden.
Objectives: To assess the nature of drug-related problems (DRPs) associated with antibiotic use and to evaluate the level of significance of clinical pharmacist interventions in surgical care. Methods: This prospective interventional study was carried out for 1 year in the wards of General Surgery. The in-patients were followed daily and reviewed for DRPs. The identified DRPs were categorized according to the Hepler and Strand classification. Drug-related problems other than those in Hepler and Strand classification were categorized separately based on medical literature and clinical practice evidence. The identified DRPs promising optimized therapy. Also, it highlights the importance of a clinical pharmacist's role in surgical care regarding patient safety.
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