Study on antibiotic use among geriatric patients based on anatomical therapeutic classification or defined daily dose methodology and world health organization-essential medicine list access, watch and reserve concept in tertiary care hospital of South India

Abstract

Background: Geriatric patients are more vulnerable to infections and need special consideration on antibiotic use. Resistance to antibiotics among infectious bacteria has developed within a short span. There is a direct correlation between the consumption of antibiotics and the development of resistance. And surprisingly very few literatures were available on antibiotic consumption in geriatric population using defined daily dose (DDD) concept which paved the idea to conduct this study.Methods: A prospective observational study was carried out from November 2018 to April 2019. A total of 206 prescriptions of elderly patients were included in the study. The antibiotics were categorized by anatomical therapeutic classification (ATC) and DDD indicator/1000 inhabitants/day (DID) was used to figure out antibiotic consumption.Results: About 25.2% of patients were treated with antibiotics for respiratory tract infections. The patients received antibiotics empirically (53.8%) and without bacteriological investigation (58.73%). The overall consumption of antibiotics was 20.47 DID in which oral antibiotics was (8.5 DID) 42% and parenteral antibiotics (11.8 DID) 58%. Cephalosporins was observed to be the most consumed antibiotics (33.2%), specifically cefotaxime (14.6%) and ceftriaxone (12.6%). Moreover, 54.4% of antibiotics consumed from watch category of World Health Organisation (WHO) essential medicines list (EML) which was completely against WHO standard proportion.Conclusions: Higher consumption of cephalosporins, which falls into watch category was analysed in geriatric patients. These broad-spectrum antibiotics have high potential to develop antimicrobial resistance. A strict antibiotic policy is needed to be framed that enhance rational prescribing practices in geriatrics.

Antibiotics use and its association with Multi-Drug Resistance in a Tertiary Care Geriatrics Hospital in Egypt

“…While, the most frequently prescribed individual antibiotics were meropenem ceftriaxone, and levofloxacin representing 14%, 14%, and 13% respectively of the total antibiotic prescriptions. This finding correlates with a previous prospective observational study including an analysis of 206 prescriptions of geriatric patients revealing that cephalosporins were the most commonly consumed antibiotics (33.2%), specifically cefotaxime (14.6%) and ceftriaxone (12.6%) [1]. This finding supports the documented frequent empirical prescribing of broadspectrum antibiotics, which have a high potential to develop AMR.…”

“…Geriatric patients are more liable to various infections that necessitate particular attention to antibiotics consumption [1]. Antibiotics are frequently utilized to treat infections, but unfortunately, they are increasingly less effective because of the ongoing antimicrobial resistance (AMR) [2].…”

“…Inappropriate use of antibiotics is frequent in frail geriatric patients [3]. Hence, special considerations on antibiotics use and selection among this vulnerable group of patients [1].…”

A Silent Pandemic of Antimicrobial Resistance: Challenges and Strategy for Preparedness in India

“…Senthilkumar et al reported 53.8% of empirical antibiotic use in a tertiary care hospital in India, among geriatric patients admitted between November 2018 and April 2019, with two thirds not having bacteriological investigations. 11 Moreover, 54.4% of the prescribed antibiotics were from WHO Watch category including cefotaxime and ceftriaxone, which goes against WHO stewardship guidance. The WHO in 2017 created the AWaRe (Access, Watch and Reserve) classification for antibiotics to prevent inappropriate use and restricting the newer class for resistant infections and recommends less than 40% of antibiotic usage to be from Watch and Reserve categories.…”

Evaluation of antibiotic consumption and compliance to hospital antibiotic policy in the surgery, orthopedics and gynecology wards of a tertiary care hospital

“…Only few Indian studies have focused on the pattern and amount of antibiotic use as well as on the level of adherence to antibiotic usage guidelines in various hospital wards to improve prescribing behavior and control irrational use of antibiotics. 5,6 Hence, the aim of this study was to assess antibiotic consumption in our hospital on the basis of volume using DDD and ranking antibiotic usage according to DU90%. The proportion of antibiotics prescribed according to the WHO AWaRe classification and compliance to hospital antibiotic policy were also determined.…”