A prospective study of the pattern of antimicrobial use in neonatal intensive care unit of a tertiary care hospital

Abstract

Background: Neonatal intensive care management (NICM) involves the use of a multiplicity of medications of different categories. Antimicrobial agents (AMAs) are the most frequently prescribed during NICM, either for prophylaxis or treatment of infections. Aims and Objectives: The objective of this study was to study the pattern of antimicrobial AMA use and criteria for their selection. Materials and Methods: Case records of 150 neonates admitted to NICU and received AMAs were analyzed prospectively for the pattern of AMA use, criteria for selection, dose, route, frequency, duration of administration, AMA combinations, and any change in AMA therapy. Results: A total of 93 male and 57 female neonates with a mean age of 3.44 days were admitted for prematurity and respiratory distress. The mean duration of hospitalization was 10.67 ± 6.29 days, and the total number of AMAs used was 20, with a mean of 2.56 per neonate. The most commonly used AMAs were aminoglycosides and beta-lactams. AMAs were used in combination in most cases (98.7%) and were rational, except ampicillin + cloxacillin. All AMAs were used by IV route, supplemented by oral/topical in 2 cases; the mean duration of administration was 6.02 days. The initial choice of AMAs was mainly empirical. Change of AMAs was required in 60.6% of cases based on clinical response/laboratory data. Conclusions: The use of AMAs in NICU was mainly empirical, and definitive therapy was based on laboratory data. AMA combinations were used in most cases, and change in therapy was based on clinical response/laboratory data.