Antimicrobial agents\' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

Abstract

Background and Aims:High utilization and inappropriate usage of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU) increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU.Methodology:A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification) as well as individual drugs and their costs were recorded.Results:One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77%) was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%), metronidazole (12%), amoxicillin/clavulanic acid (6.44%), and azithromycin (4.34%). Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR).Conclusion:A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.

A study on antimicrobial agents utilization pattern using anatomical therapeutic chemical / daily defined dose system and adverse drug reaction pattern in the intensive care unit of a tertiary care teaching hospital in North Eastern state of India

“…1 Moreover AMAs are most frequently prescribed drugs in ICU. 2,11 Increasing multidrug resistance with limited availability of newer agents there is urgent need for vigilant surveillance, stringent infection control as well as rational antibiotic prescription1. 1,15 The clinical setting in the medical ICU warrants the use of drugs from various drug classes.…”

“…Study tool, data measurement and format of analysis: 2,[6][7][8][9][10] All the patients admitted in ICU during the study period were explained clearly about the purpose and nature of the study and written informed consent was taken before including them in the study. All the patients were interviewed daily.…”

“…1 About 5000 antimicrobial agents (AMAs) have been discovered till date, out of which only around 100 are used clinically for treating infection. 2 AMAs deserve their place as one of the most powerful pillars of modern medical care. 3 Antimicrobial agents are prescribed very often inappropriately and they have become one of the highly abused drugs.…”

“…7 There is continuing emergence of resistant pathogen and unfortunately, as the need for new AMA has grown over time, development of novel drugs has been slow in the recent years. 2 Drug utilization study is a great tool for analyzing and evaluating prescribing pattern of medical professionals and also helps in formulating drug and antibiotics policy. 1 The ICU has been known to be the land of polypharmacy.…”

A Prospective Study on Antimicrobial Utilization Pattern in Outpatient Department at Tertiary Care Hospital, Pune, India.

“…Betalactams are commonly used AMA and use abundantly in practice. There are many studies who found same result [4,7,[9][10][11][12][13].Beta-lactams are well established AMAs regarding their efficacy and safety that may lead to its widespread use. Pallavi et al found broad-spectrum antibiotic was most common in their study [5].…”