Antibiotic prescribing in medical intensive care units – a comparison between two private sector hospitals in Central India

Sharma, Megha; Damlin, Anna; Sharma, Ashish; Lundborg, Cecilia Stålsby

doi:10.3109/00365548.2014.988747

Cited by 22 publications

(64 citation statements)

References 15 publications

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“…However, prescribing of broad-spectrum antibiotics in both hospitals was high, which is in line with previous reports on prescribing of broad-spectrum antibiotics in Indian hospitals [12,20]. As all the patients in the NTH paid for the treatment they received, the patients might have put pressure on their physicians to prescribe broad-spectrum antibiotics.…”

Section: Discussionsupporting

confidence: 85%

“…In only a small number of cases in the present study, samples were sent for microbiological analyses, despite such analyses being readily available in both hospitals. Patient-and prescriber-related factors have been put forward to explain why culture tests are not routinely performed in the hospitals [12,21,30]. Patient-related factors include patients not being able to afford the tests or prefer to stay for short periods to pay less at the NTH.…”

Section: Discussionmentioning

confidence: 99%

“…Patient-related factors include patients not being able to afford the tests or prefer to stay for short periods to pay less at the NTH. Prescriber-related factors might include doctors not having the time to wait for lab results due to overcrowding in the hospitals or an additional factor may be monetary driven, that doctors are paid for the number of patients they admit to the hospital so they might be wishing to see as many patients as possible in a given period [12,21,30]. Routine use of diagnostic methods, such as microbiological analysis and imaging methods, for patients with suspected infections might contribute to better management of and guidance on antibiotic treatment for infectious diseases to reduce antibiotic overuse.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – A time series analysis over 10 years

Damlin

Sharma

Marrone

et al. 2020

Preprint

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Background Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended. Methods Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization’s (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values <0.05 were considered significant. Results In total, 3,766 patients were included, 2,504 inpatients in the NTH and 1,262 in the TH, of which 92% and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO’s second-choice of treatment, the watch category, comprised 29% and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P <0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P <0.05). Conclusions Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – A time series analysis over 10 years

Damlin

Sharma

Marrone

et al. 2020

Preprint

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“…Despite this, limited studies have been conducted on the surveillance of antibiotic prescribing at the Indian private healthcare sector, and a few conducted, showed overall high antibiotic prescriptions (5,13,14). These findings are in line with the available evidence of the high use of antibiotics and the presence of various multidrug-resistant bacterial strains in the country (15,19).…”

supporting

confidence: 66%

“…The surveillance of the use of antibiotics according to the indications is one of the cornerstones to develop strategies for the improvement of the use of antibiotics and to slow down the development of ABR (4,11,12). So far, the published studies have not presented the antibiotic prescriptions for specific indications (13)(14)(15).…”

mentioning

confidence: 99%

Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India

Machowska

Landstedt

Lundborg

et al. 2020

Preprint

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Background: Patients in obstetrics and gynaecology (OBGY) departments are at high risk of life-threatening infection, thus prescribed antibiotics extensively. The use of antibiotics leads to increasing antibiotic resistance (ABR). Antibiotic surveillance is one of the cornerstones to combat ABR. However, surveillance of, department specific antibiotic prescription data is rarely performed, especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH), in Central India. Methods: A prospective study was conducted for three years using. Demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration and frequency were recorded for all inpatients during their hospital stay. The patients were divided into, infectious and non-infectious diagnosis categories and further into surgical, non-surgical and possible surgical indications using the International Classification of Disease system version-10. Results: A total of 5558 patients were included in the study; 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotics (p<0.001). A majority of the patients with surgical indications were prescribed antibiotics (TH-87%, NTH-100%). Prescribing of the fixed-dose combinations (FDCs) of antibiotics and use of trade names were more common at the NTH. Most of the inpatients who had neither surgery nor any confirmed bacterial infection received antibiotics (TH-71% and NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: High antibiotic prescribing for the inpatients having no infection indications in both hospitals, as well as frequent prescribing of trade-name, broad-spectrum antibiotics, including the FDCs in the NTH than the TH, are points of concern. Investigation of the underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the antibiotic prescribing practice.

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Determinants of Antibiotic Consumption - Development of a Model using Partial Least Squares Regression based on Data from India

Tamhankar

Karnik

Lundborg

2018

Sci Rep

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Antibiotic resistance, a consequence of antibiotic use, is a threat to health, with severe consequences for resource constrained settings. If determinants for human antibiotic use in India, a lower middle income country, with one of the highest antibiotic consumption in the world could be understood, interventions could be developed, having implications for similar settings. Year wise data for India, for potential determinants and antibiotic consumption, was sourced from publicly available databases for the years 2000–2010. Data was analyzed using Partial Least Squares regression and correlation between determinants and antibiotic consumption was evaluated, formulating ‘Predictors’ and ‘Prediction models’. The ‘prediction model’ with the statistically most significant predictors (root mean square errors of prediction for train set-377.0 and test set-297.0) formulated from a combination of Health infrastructure + Surface transport infrastructure (HISTI), predicted antibiotic consumption within 95% confidence interval and estimated an antibiotic consumption of 11.6 standard units/person (14.37 billion standard units totally; standard units = number of doses sold in the country; a dose being a pill, capsule, or ampoule) for India for 2014. The HISTI model may become useful in predicting antibiotic consumption for countries/regions having circumstances and data similar to India, but without resources to measure actual data of antibiotic consumption.

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Antibiotic prescribing in medical intensive care units – a comparison between two private sector hospitals in Central India

Abstract: Antibiotic prescribing was common at both hospitals. The antibiotic prescriptions at the TH had higher compliance to WHOLEM and NLEMI. However, there is a need to develop appropriate interventions to improve antibiotic prescribing at both hospitals.

Cited by 22 publications

References 15 publications

Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – A time series analysis over 10 years

Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – A time series analysis over 10 years

Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India

Determinants of Antibiotic Consumption - Development of a Model using Partial Least Squares Regression based on Data from India

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