A Prospective Study on Assessment of Rationality in Prescribing Antimicrobial Agents at a Tertiary Care Hospital

Abstract

Introduction: Antimicrobial Agents (AMAs) rationality has become the most prevalent issue world wide as the irrational prescribing is leading to antimicrobial resistance. So, reporting interventions and identification of drug related problems, may help in avoidance or control or prevention the antimicrobial resistance. Aim: To assess rationality in usage of AMAs in both infectious and non infectious conditions at a tertiary care hospital using ICMR guidelines, National Treatment Guidelines for Antimicrobial Use in Infectious Diseases, PCNE guidelines. Materials and Methods: A prospective observational study was carried out at inpatient department in a tertiary care hospital. The data of 260 cases were collected and recorded during regular ward rounds and were thoroughly analysed to evaluate inappropriateness in drug usage by ICMR guidelines, WHOINRUD drug core indicators, Pharmaceutical Care Network Europe (PCNE) guidelines and Essential Drug List (EDL). Data analysed also included the results on patient’s demographics (age, gender, type of AMAs etc.,). Errors obtained were reported to physician. Data analysis was performed using descriptive analysis. Results: The findings of the study reveals that the average age of high incidence with AMAs was found to be 55.5 years, where male population were majority with 52% and female with 48% of AMAs prescriptions. Non infectious conditions (56.5%) were more than the infectious conditions (43.4%). Among 487 drugs prescribed in 260 prescriptions majority of them were antibiotic drugs (480), followed by antifungal drugs (6) and antiviral drug (1). The most commonly prescribed category of antibiotic was cephalosporins with 100 drugs (22.5%), along with fixed dose combinations of 162 drugs (33.2%). More number of prescriptions were found with two antibiotics (104). Among all prescriptions 46 were found to be irrational and 214 prescriptions were rational, the irrationality was found mostly due to drug interactions. At the end of the study six types of drug related problems were identified in 46 prescriptions such as wrong drug (2), wrong dose (14), wrong frequency (5), drug interactions (28), therapeutic duplication (5), wrong indication (7). According to WHO INRUD guidelines average number of antibiotics per prescription was 1.87, percentage of antibiotics prescribed by generic name was 36.34%, percentage of encounters with an antibiotic prescribed was 100%, percentage of encounters with an injection prescribed was 73.26%, percentage antibiotics prescribed from EDL was 30.7%. Length of stay of 52% patients having AMAs in their prescription was more than five days, where as 19% of patients were admitted for less than five days. The average cost of antibiotics per prescription was found to be Rs 3800, whereas the equivalent antibiotics with different brands the cost was Rs.1282.04. Conclusion: At the end of the study six types of drug related problems were identified in 46 prescriptions such as wrong drug, wrong dose, wrong frequency, therapeutic duplication, wrong indication, drug interactions, which lead to irrational prescriptions. Hence, there is a necessity of clinical pharmacist in hospital for minimising errors, thereby preventing the development of resistance towards antibiotics and reducing the prescription cost.

Keywords

• essential drug list
• indian council of medical research (icmr) guidelines
• pharmaceutical care network europe classification
• world health organisation-drug core indicators