Utilisation Pattern, Safety Profile and Cost Analysis of Antimicrobials Prescribed in an Intensive Care Unit of a Teaching Hospital

Abstract

Introduction: Drug utilisation studies are the corner stone of pharmaco-epidemiology. They give us an overview of the pattern, quality and outcome of drug use, which can help in rationale use of medications. Antimicrobial Agents (AMA) are the frequently utilised drugs in an Intensive Care Unit (ICU) setting because of frequent infection, eventually leading to poor adherence with evidence based guidelines and broad-spectrum antibiotic overuse. There is need to conduct many studies to educate the prescribers, the rational drug therapy for safety and benefit to the patient. Aim: To estimate utilisation and prescribing trends of AMAs in medical (MICU) and to evaluate their safety in respect to the adverse drug reaction and their cost analysis in medical ICU. Materials and Methods: A prospective observational study was conducted on 123 patients during February 2016 to February 2017. The demographic data, disease data, the utilisation of different classes of AMAs as well as individual drugs, their safety and costs were recorded. Their prescribing pattern was assessed using WHO prescribing indicators. Causality of adverse drug reactions assessed using WHO-UMC causality assessment scale. Descriptive statistics was used for data analysis. Results: Prescription with single drug accounted for 34.15% and combination of AMAs was 65.85%. Out of 123 patients admitted in MICU, most common cause was respiratory tract infections (24.39%). Ceftriaxone was the most common single AMA (n=56, 29.95%) prescribed. Ceftriaxone+metronidazole were commonly used combination (n=19, 15.44%). Polypharmacy (7-8) was seen as compared to WHO indicators (2-3). Overuse of injections noticed. Percentage of drugs (30.67%) prescribed by generic name was low. Percentage of drugs from Essential Drug List (EDL) (90.41) was comparable to WHO (80-100). Cost of Betalactams for single day was Rs 14963/-. The causality of Adverse Drug Reaction (ADR) was probable. Conclusion: An increased usage of AMAs were noticed which has led to the high cost of the treatment procedures. Frequent use of newer group of antibiotics was noticed. Data of antimicrobial utilisation pattern are required for planning an antibiotic policy.

Keywords

• antimicrobial usage
• causality assessment
• daily defined dose
• drug utilisation studies
• nosocomial infections