Antibiotics: Need for new fences”, a prospective utilization evaluation of cephalosporin's and its combination in tertiary care referral hospital

Abstract

Background:The cephalosporins are a large group of related β-lactam antimicrobial agents with broad spectrum of activity. Drug Utilization and Evaluation (DUE) is an ongoing, structured process to analyse the pattern of drug administration in various practice settings, including hospitals in relation to guidelines or predetermined standards thereby promoting the appropriate and effective use of drugs. Methods: This prospective interventional study was conducted for a duration of six months among the in-patients of various departments of a multispecialty hospital located in Kerala, India. Cephalosporins were evaluated. Results: Study conducted over a period of 6 months revealed that most of the therapy was definite 45% (n = 120) followed by empirical 32% (n = 85) and the least type was prophylactic 23% (n = 62) (ᵡ2 = 16.965, d.f = 2, p < 0.0010). Inappropriate use of cephalosporins were noted in 30 out of 267 cases (11.2%). Among these majority 93% (n = 28) were wrong drug selection followed with wrong days of therapy and failure of deescalation, 3.33% (n = 1) each. In 13% (n = 8) cases, drug was given beyond the actual duration. De-escalation was not done in 4% (n = 3) cases and in 8% (n = 5) cases the treatment was done against the culture and sensitivity pattern. The most common drug used in combination with cephalosporins was metronidazole (36%). Conclusion: Extensive use of third generation cephalosporin was observed in the study with facts and figures revealing their inappropriate use. This climaxes the need of continuous educational intervention by clinical pharmacist along with the modification of hospital antibiotic policy.

Prescribing Practice of Third Generation Cephalosporins in Medical Wards at Hospital Queen Elizabeth II (HQEII)

“…Out of 137 patients, only 4 patients (3%) were started with cefotaxime. A study conducted in Trinidad found that 26.5% of patients were started with cefotaxime (Pinto Pereira et al, 2004) and only 1% of patients was started with cefotaxime in India (Chandrasekhar et al, 2020). Up until today, no other studies that research the use of thirdgeneration cephalosporins state the specific use of cefotaxime and other antibiotics under third-generation cephalosporins.…”