Antibiotic prescribing in outpatients: Hospital and seasonal variations in Ujjain, India

Pathak, Ashish; Mahadik, Kalpana; Dhaneria, Suryaprakash; Sharma, Ashish; Eriksson, Bo; Lundborg, Cecilia Stålsby

doi:10.3109/00365548.2011.554854

Cited by 38 publications

(46 citation statements)

References 16 publications

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“…In the present study, resistance to cotrimoxazole was documented to be >80%, which is in accordance with the high-resistance rates recorded in other Indian studies 27. Most patients at the two study sites were treated with norfloxacin in outpatient clinics 28. Because quinolones select more antibiotic-resistant strains and nitrofurantoin shows good activity against E. coli , nitrofurantoin would serve as better alternative first-line drug for the treatment of uncomplicated urinary tract infection in this setting.…”

Section: Discussionsupporting

confidence: 90%

High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Pathak

Marothi²,

Kekre³

et al. 2012

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BackgroundRecent reports of the rapid evolution of bacterial resistance in India require urgent antibiotic stewardship programs. This study aimed to define the magnitude and pattern of resistance of bacterial pathogens to guide empirical therapy.MethodsWe prospectively collected consecutive, clinically significant, and nonduplicate bacterial isolates from each patient from two hospitals in Ujjain, India. The antibiotic susceptibility of the bacteria was tested using a disc diffusion method as recommended by the Clinical and Laboratory Standards Institute.ResultsA total of 716 pathogens were isolated from 2568 patients (median age, 25 years; range, 0 days to 92 years). Gram-negative infections were predominant (62%). The isolated pathogens included Staphylococcus aureus (n = 221; 31%), Escherichia coli (n = 149; 21%), Pseudomonas aeruginosa (n = 127; 18%), and Klebsiella pneumoniae (n = 107; 15%). Common diagnoses included abscesses (56%), urinary tract infections (14%), blood stream infections (10%), pneumonia (10%), and vaginal infections (10%). In E. coli isolates, 69% (95% confidence interval [CI] 61.6–76.6) were extended-spectrum β-lactamase (ESBL) producers and 41% (95% CI 31.6–50.5) of K. pneumoniae isolates were ESBL producers. These isolates had a high resistance to fluoroquinolones and β-lactams, except for imipenem and piperacillin-tazobactam. Salmonella typhi remained sensitive to third-generation cephalosporins. Methicillin-resistant S. aureus (MRSA) constituted 30% of all S. aureus isolates and showed resistance to ciprofloxacin (81%), cotrimoxazole (76%), and levofloxacin (60%).ConclusionOur results showed a high prevalence of ESBL among Gram-negative bacterial isolates and a high prevalence of MRSA among S. aureus isolates. Carbapenems provided the broadest coverage for Gram-negative bacteria, while glycopeptides were the most effective against MRSA; however, both classes of drugs need to be used judiciously. This study will help in planning future antibiotic stewardship programs.

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Section: Discussionsupporting

confidence: 90%

High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Pathak

Marothi²,

Kekre³

et al. 2012

IDR

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“…In the few studies conducted, wide variation has been demonstrated in resistance rates of E. coli isolates from reportedly healthy children [6,7]. In the geographical area of the present study, high rate of broad-spectrum antibiotic prescribing for self-limiting conditions has been shown among children [8,9]. The high rate of antibiotic prescribing is likely to result in high rates of resistance.…”

Section: Introductionmentioning

confidence: 56%

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

et al. 2013

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BackgroundAntibiotic resistance is a major global public health concern, particularly in settings where few treatment options are available. Limited research has been done on antibiotic resistance in Escherichia coli of Indian children at community level. Therefore we studied antibiotic resistance patterns in E. coli isolates from stool samples of children aged 3-14 years from Ujjain, Central India, to investigate associations of resistance with demographic variables.MethodsChildren, 3-14 years of age, were included from 30 randomly selected villages of Palwa demographic surveillance site, Ujjain, India. Parents were interviewed using a questionnaire, and stool samples were collected from participating children. E. coli were isolated from stool samples (n = 529), and susceptibility testing to 18 different antibiotics was done using standard methods.ResultsThe proportions of isolates resistant to various antibiotics were, nalidixic acid, (45%), tetracycline (37%), ampicillin (37%), sulfamethoxazole/trimethoprim (29%) and amoxicillin/clavulanic acid (29%). No isolates were resistant to imipenem. Overall, 72% of isolates were resistant to at least one antibiotic and 33% were multi-drug resistant. High rates of cross-resistance were seen for 15 (83%) of the antibiotics studied. E. coli isolates from children with literate mothers were more resistant to penicillins and fluoroquinolones. ESBL-producers comprised 9% of the isolates.ConclusionAntibiotic resistance and cross-resistance were common in E. coli from stools of children. Resistance rates were associated with maternal literacy.

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“…A high antibiotic use rate has been reported both in the outpatients [6] and among admitted patients [31] in the same geographical area i.e. Ujjain.…”

Section: Discussionmentioning

confidence: 99%

“…Preventing further spread of MRSA has become a major global public health problem [3,4]. Antibiotic use is the main determinant of extent of antibiotic resistance in a given geographical area [5,6]. The spread of multi-resistant strains of bacteria in the community is compounded with a paucity of new classes of antibiotics in the pipeline [7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for nasal carriage of Staphylococcus aureus in children attending anganwaries (preschools) in Ujjain, India

et al. 2013

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BackgroundChildren with nasal carriage of S. aureus play an important role in community spread of S. aureus and methicillin-resistant S. aureus (MRSA). Screening the nasal carriage isolates of S. aureus for antibiotic resistance patterns will provide guidelines for empiric therapy of community-acquired infections. The aim of the present study was to determine the prevalence of S. aureus and MRSA and it’s in vitro antibiotic susceptibility pattern among children in anganwaries (preschools) of Ujjain city India. This work is an extension to our previous publication in BMC Pediatrics (http://www.biomedcentral.com/1471-2431/10/100).MethodsA prospective study was done among children aged 1 to 6 years of age attending 100 anganwaries chosen purposely for the study to evenly cover the city. From each anganwari 10 children were randomly selected for nasal swabbing. Children having pyoderma were not included. Information on risk factors for nasal colonization was collected using a pre-tested questionnaire. Swabs from anterior nares were plated on 5% sheep blood agar. Antibiotic susceptibility tests were performed using Kirby-Bauer’s disc diffusion method according to performance standards of Clinical and Laboratory Standard Institute guidelines.ResultsA total of 1002 children were included in the study. The prevalence of S. aureus nasal carriage was 35% (95% confidence interval CI 32.07 to 37.98) and that of MRSA nasal carriage was 29% (95% CI 24.28 to 33.88). The factors that were independently associated with nasal carriage of S. aureus were: “age-group” i.e. as the age increased beyond the age of 2 years the OR of nasal carriage decreased, “family size of more than 10 members” OR 2.59 (95% CI 1.53-4.37; P < 0.001), and protein energy malnutrition Grade 3 or 4 (OR 1.40, 95% CI 1.04-1.90; P = 0.026). The resistance pattern of S. aureus and MRSA showed resistance not only to single antibiotic class but co-resistance and multi-drug resistance was also common.ConclusionsThe high rates of nasal carriage of S. aureus and MRSA and presence of resistance to commonly used antibiotics are disturbing. Antibiotic stewardship programmes that promote judicious use of antibiotic along with strategies to prevent community spread of S. aureus are urgently needed.

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Antibiotic prescribing in outpatients: Hospital and seasonal variations in Ujjain, India

Abstract: The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings.

Cited by 38 publications

References 16 publications

High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

Prevalence and risk factors for nasal carriage of Staphylococcus aureus in children attending anganwaries (preschools) in Ujjain, India

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Antibiotic prescribing in outpatients: Hospital and seasonal variations in Ujjain, India

Abstract: The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings.

Cited by 38 publications

References 16 publications

High prevalence of extended-spectrum &beta;-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

High prevalence of extended-spectrum &beta;-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

Prevalence and risk factors for nasal carriage of Staphylococcus aureus in children attending anganwaries (preschools) in Ujjain, India

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High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India