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Ismail D. Antibiotics Cost in Medical Intensive Care. J Hosp Infect 2022; 124:47-55. [DOI: 10.1016/j.jhin.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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Marasine NR, Shrestha S, Sankhi S, Paudel N, Gautam A, Poudel A. Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal. SAGE Open Med 2021; 9:20503121211043710. [PMID: 34504707 PMCID: PMC8422810 DOI: 10.1177/20503121211043710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs. Objective: This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal. Methods: A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. Results: A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Conclusion: This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.
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Affiliation(s)
- Nirmal Raj Marasine
- Department of Pharmacy, Karnali College of Health Science, Kathmandu, Nepal.,School of Pharmacy, Chitwan Medical College, Bharatpur, Nepal
| | - Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Sabina Sankhi
- Department of Pharmacy, Modern Technical College, Lalitpur, Nepal
| | - Nabina Paudel
- School of Pharmacy, Kathmandu University, Dhulikhel, Nepal
| | - Ashish Gautam
- School of Pharmacy, Chitwan Medical College, Bharatpur, Nepal
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Nabovati E, TaherZadeh Z, Eslami S, Abu-Hanna A, Abbasi R. Antibiotic prescribing in inpatient and outpatient settings in Iran: a systematic review and meta-analysis study. Antimicrob Resist Infect Control 2021; 10:15. [PMID: 33446279 PMCID: PMC7809737 DOI: 10.1186/s13756-021-00887-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Antibiotic prescribing is common worldwide. There are several original studies about antibiotic prescribing in the healthcare setting of Iran reporting different levels of prescribing. The aim of this systematic review and meta-analysis was to determine the prevalence of antibiotic prescribing in both inpatient and outpatient settings in Iran, an example of a developing country. Methods To identify published studies on antibiotic prescribing, databases such as ISI, Scopus, PubMed, Google Scholar, and Electronic Persian were searched in Iran till January 2020. Eligible studies were those analyzing original data on the prescription and use of antibiotics in outpatient or inpatient settings in Iran. Moreover, all studies that used an intervention to improve antibiotic prescribing were included. The quality of the included studies was assessed using self-administered quality assessment criteria. The meta-analysis of prevalence of antibiotic prescribing was conducted based on the meta-analysis of observational studies in epidemiology guidelines. To calculate pooled rates, the random-effects model was used. Results A total of 54 studies (39 outpatients and 15 inpatients) were included in this study. The median of antibiotic prescribing in the outpatient and inpatient settings accounted for 45.25% and 68.2% of patients, respectively. The results of meta-analysis also showed that the antibiotic prescribing accounted for 45% of prescriptions in outpatient settings and 39.5%, 66%, and 75.3% of patients in all wards, pediatrics wards, and ICU wards of inpatient settings, respectively. The most commonly prescribed antibiotic classes in outpatient settings were penicillins, cephalosporins, and macrolides, while in inpatient settings, these were cephalosporins, penicillins, and carbapenems. There were seven studies using interventions to improve antibiotic prescribing pattern. It should be mentioned that intervention in a study had a statistically significant effect on improving antibiotic prescribing (p < .05). Conclusion Prevalence of antibiotic prescribing in Iran is high. Our findings highlight the need for urgent action to improve prescription practices. It seems that developing a national plan to improve antibiotic prescribing is necessary.
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Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Zhila TaherZadeh
- Targeted Drug Delivery Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reza Abbasi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran. .,Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran.
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Jovanovic B, Djuric O, Hadzibegovic A, Jovanovic S, Stanisavljevic J, Milenkovic M, Rajkovic M, Ratkovic S, Markovic-Denic L. Trauma and Antimicrobial Resistance Are Independent Predictors of Inadequate Empirical Antimicrobial Treatment of Ventilator-Associated Pneumonia in Critically Ill Patients. Surg Infect (Larchmt) 2021; 22:730-737. [PMID: 33439780 DOI: 10.1089/sur.2020.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: We aimed to assess independent risk factors for inadequate initial antimicrobial treatment (IAT) in critically ill patients with ventilator-associated pneumonia (VAP) treated in intensive care units (ICU) and to determine whether IAT is associated with adverse outcomes in patients with VAP. Patients and Methods: A prospective cohort study was performed and included 152 patients with VAP treated in an ICU for more than 48 hours. The main outcomes of interest were all-cause ICU mortality and VAP-related mortality. Other outcomes considered were: intra-hospital mortality, VAP-related sepsis, relapse, re-infection, length of stay in ICU (ICU LOS), and number of days on mechanical ventilation (MV). Results: One-third of patients (35.5%) received inadequate antimicrobial therapy. Trauma (odds ratio [OR], 3.55; 95% confidence interval [CI], 1.25-10.06) and extensively drug-resistant (XDR) causative agent (OR, 3.09; 95% CI, 1.23-7.74) were independently associated with inadequate IAT. Inadequate IAT was associated with a higher mortality rate (OR, 3.08; 95% CI, 1.30-7.26), VAP-related sepsis (OR, 2.39; 95% CI, 1.07-5.32), relapse (OR, 3.25; 95% CI, 1.34-7.89), re-infection (OR, 6.06; 95% CI, 2.48-14.77), and ICU LOS (β 4.65; 95% CI, 0.93-8.36). Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella/Enterobacter spp. were the most common bacteria in patients with IAT and those with adequate antimicrobial therapy. Conclusions: This study demonstrated that inadequate IAT is associated with a higher risk of the majority of adverse outcomes in patients with VAP treated in ICUs. Trauma and XDR strains of bacteria are independent predictors of inadequate IAT of VAP in critically ill patients.
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Affiliation(s)
- Bojan Jovanovic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Olivera Djuric
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Adi Hadzibegovic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Jovanovic
- Department of Microbiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovana Stanisavljevic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Milenkovic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Rajkovic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Ratkovic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Markovic-Denic
- Faculty of Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Hallit S, Zahreddine L, Saleh N, Shakaroun S, Lahoud N. Practice of parents and pharmacists regarding antibiotics use in pediatrics: A 2017 cross-sectional study in Lebanese community pharmacies. J Eval Clin Pract 2020; 26:181-189. [PMID: 31111612 DOI: 10.1111/jep.13165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess practices of community pharmacists towards prescribing or dispensing antibiotics without prescription to children, determine obstacles that stand in the way of best practices, and determine whether parents misuse antibiotics when administering them to their children. METHODS A cross-sectional study, conducted between June 2017 and August 2017 on a random sample of community pharmacies, enrolled 202 community pharmacists and 204 parents. RESULTS A total of 84.6% of pharmacists prescribed antibiotics for children in community pharmacies, particularly for the treatment of pharyngitis (67.5%), otitis media (56%), or diarrhea/vomiting (40.4%); 54.2% of these pharmacists reported prescribing antibiotics to children under 2 years of age, while 14.4% reported only prescribing antibiotics for children aged six and above. Most pharmacists cited pressure from the child's parents as a reason for prescribing antibiotics, while parents not being able to afford the doctor's visit was cited by 24.7%. When dispensing antibiotics for use by children, 23.5% of the pharmacists reported recommending a small or large spoon two to three times daily, regardless of the standard dose or the child's weight. In addition, 21.7% of the pharmacists reported always dispensing the entire bottle of antibiotics, while 5.4% do not specify the treatment's duration. From the parents' side, 38% reported that the most recent purchase of an antibiotic for their child was made without a medical prescription, while 20.6% reported that they did not follow medical instructions regarding treatment's dosage and duration; 64.3% reported ending the antibiotic treatment early if their child felt better. Most of the parents reported diluting the antibiotic incorrectly, with half of them not shaking the bottle well enough before adding in water. CONCLUSION These study results demonstrated poor practices of community pharmacists towards dispensing antibiotics without a prescription, and in parents when administering them to their children. Educational campaigns to increase awareness on antibiotics misuse in pediatrics are warranted.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | | | - Nadine Saleh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon.,Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | | | - Nathalie Lahoud
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon.,Faculty of Public Health, Lebanese University, Fanar, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
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Patra SK, Mishra SB, Rath A, Samal S, Iqbal SN. Study of Antimicrobial Utilization and Cost of Therapy in Medicine Intensive Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2020; 24:938-942. [PMID: 33281318 PMCID: PMC7689122 DOI: 10.5005/jp-journals-10071-23552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction High utilization of antimicrobial agent (AMA) and inappropriate usage in an intensive care unit (ICU) intensifies resistant organism, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. To analyze and compare the utilization of drugs, the World Health Organization (WHO) proposed daily defined dose (DDD)/100 patient days and days of therapy (DOT)/100 patient days to measure utilization of AMAs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Materials and methods A prospective observational study was conducted for 1 year from July 2018 to June 2019 and the data obtained from ICU of a tertiary care hospital. The demographic data, the disease data, and the utilization of different classes of AMAs [WHO-Anatomical Therapeutic Chemical (ATC) classification] as well as their cost were recorded. Total number of patient days, DDD, DDD/100 patient days, and DOT/100 patient days were calculated as proposed by the WHO. Statistical analysis was performed using statistical software SPSS version 25.0. The descriptive analysis was performed using summary statistics median [interquartile range (IQR)]. Results A total 939 patients were included, out of them 332 (35.4%) were female. The median age of the total patients was 58 (45-70). The median length of stay in ICU was 3 days. Mortality rate during our study period was 38.6%. The highly utilized AMAs in our study was ceftriaxone (36.95 DDD/100 patient days) followed by piperacillin/tazobactam (31.57), meropenem (26.4), doxycycline (21.53), and polymyxin B (21.38). The association between APACHE II and SOFA score with use of restricted antibiotics found to be statistical significant (p value 0.018 and 0.000, respectively). The cost of antibiotics per patient and patient days were $449.97 and $93.77, respectively, while median value of total cost was $2,343.26. Conclusion Ceftriaxone was the highest utilized AMA. The risk of receiving restricted antibiotics intensified with increasing prevalence of multidrug resistance bacteria and associated comorbidities. High treatment cost is responsible for higher utilization of restricted antibiotics in ICU. How to cite this article Patra SK, Mishra SB, Rath A, Samal S, Iqbal SN. Study of Antimicrobial Utilization and Cost of Therapy in Medicine Intensive Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2020;24(10):938-942.
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Affiliation(s)
- Shantanu K Patra
- Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Shakti B Mishra
- Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Arun Rath
- Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Samir Samal
- Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sheikh Nurul Iqbal
- Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
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Abdalla SN, Yousef BA. Prescribing patterns of antimicrobials in the Internal Medicine Department of Ibrahim Malik Teaching Hospital in Khartoum, 2016. Pan Afr Med J 2019; 34:89. [PMID: 31934232 PMCID: PMC6945680 DOI: 10.11604/pamj.2019.34.89.17023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/07/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Antimicrobials are among the most commonly prescribed therapeutic agents in hospitals. Irrational use of antimicrobials results in the development of antimicrobial resistance which could lead to life-threatening illnesses. Therefore, the assessment of antimicrobial prescribing and use is of utmost importance. This study aimed to examine the prescribing patterns of antimicrobials in the Internal Medicine Department of Ibrahim Malik Teaching Hospital in Khartoum, Sudan. Methods A descriptive, cross-sectional study was conducted using World Health Organization (WHO) indicators for antimicrobial use in hospitals. Systematic random sampling was used to select 245 medical records from the 2613 medical records of patients admitted to the internal medicine department in 2016. Data were collected using a data collection form and a structured interview with the chief pharmacist in the hospital. Results Of the 245 medical records examined, 201 (82%) patients were prescribed one or more antimicrobial drug. The average number of antimicrobials per patient was (2.1±1.1). The average duration of antimicrobial treatment was (4.9±3.8) days. The generic name was used in (35.6%) of antimicrobials, while (95.5%) of all antimicrobials were prescribed from the national essential medicines list. Overall, there were 421 courses of antimicrobials prescribed. The most frequently prescribed antimicrobials were ceftriaxone (131 courses) and metronidazole (89 courses). Among the documented infectious diseases, the most frequently encountered was pneumonia, followed by malaria. There was no drug and therapeutic committee, hospital formulary or essential medicines list, and standard treatment guidelines for infectious diseases in the hospital. Conclusion The results of the study revealed a high percentage of antimicrobial use in the Internal Medicine Department. Multifaceted interventions are urgently needed to promote rational prescribing of antimicrobials.
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Affiliation(s)
- Salma Nasr Abdalla
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Sudan
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Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrob Resist Infect Control 2019; 8:35. [PMID: 30805182 PMCID: PMC6373132 DOI: 10.1186/s13756-019-0471-0] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.
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Affiliation(s)
- Dilip Nathwani
- 1Ninewells Hospital and Medical School, Dundee, DD19SY UK
| | - Della Varghese
- 2Pharmerit International, 4350 East West Highway, Suite 1100, Bethesda, MD 20184 USA
| | - Jennifer Stephens
- 2Pharmerit International, 4350 East West Highway, Suite 1100, Bethesda, MD 20184 USA
| | | | - Stephan Martin
- 2Pharmerit International, 4350 East West Highway, Suite 1100, Bethesda, MD 20184 USA
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Shah N, Joshi A, Ganguly B. Impact of Antibiotic Stewardship Program on Prescribing Pattern of Antimicrobials in Patients of Medical Intensive Care Unit. J Clin Diagn Res 2017; 11:FC11-FC15. [PMID: 28892925 DOI: 10.7860/jcdr/2017/27171.10237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/18/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rising concerns about antimicrobial resistance and inadequate development of effective new anti-infective drugs have stimulated universal efforts to strengthen infection-control interventions. Antimicrobial stewardship is a rational, systematic approach to promote the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use in order to improve the outcomes. AIM Since in Shree Krishna Hospital (SKH), Antibiotic Stewardship Program (ASP) was first implemented in 2013, this study was planned to assess any change in antimicrobial use before and after implementation of ASP and to study the rate and pattern of antimicrobial use in medical ICU. MATERIALS AND METHODS A cross-sectional study was conducted in 12 bedded medical intensive care unit, over a period of two years from October 2014 to October 2016 at SKH. Permission was taken from Institutional Human Research Ethics Committee. Total 150 case files i.e., 75 from year 2012 and 75 from year 2015 were retrieved from medical record section of the hospital. Appropriateness of prescriptions was decided on the basis of appropriateness of choice, dose, frequency and duration of antimicrobial agents. Data were analysed by using descriptive statistics. RESULTS There were 68.67% males and the mean (±SD) age was 57.11 (±16.83) years. Majority of the patients were suffering from respiratory conditions. The most common group of drugs prescribed in MICU was β-lactam antibiotics + β-lactamase inhibitors during 2012 as well as 2015. Total 139 patients i.e., 69 (92%) patients in 2012 and 70 (93.33%) patients in 2015 were given antimicrobial for therapeutic purpose. During the year 2015, 67 (89.33%) antimicrobial prescriptions were adhering to antibiotic policy of SKH. Appropriateness of prescriptions had significantly improved in 2015 in MICU (p-value=0.031). CONCLUSION In-depth analysis of the study revealed a positive impact of ASP and antibiotic policy. Implementation of ASP in year 2013, brought an effective increase in the appropriate use of antimicrobials.
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Affiliation(s)
- Nishal Shah
- Resident, Department of Pharmacology, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Anuradha Joshi
- Associate Professor, Department of Pharmacology, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Barna Ganguly
- Professor and Head, Department of Pharmacology, Pramukhswami Medical College, Karamsad, Gujarat, India
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Baadani AM, Baig K, Alfahad WA, Aldalbahi S, Omrani AS. Physicians' knowledge, perceptions, and attitudes toward antimicrobial prescribing in Riyadh, Saudi Arabia. Saudi Med J 2016; 36:613-9. [PMID: 25935184 PMCID: PMC4436760 DOI: 10.15537/smj.2015.5.11726] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess knowledge, perceptions, and attitudes toward antimicrobial prescribing among physicians practicing in Riyadh, Saudi Arabia. METHODS A questionnaire was developed and distributed to physicians working in hospitals in Riyadh, Saudi Arabia between June and August 2013. The results were analyzed using Stata 12 software. RESULTS Two hundred and twelve (84.8%) full responses were returned. Most respondents perceived antimicrobial resistance as a significant problem in their daily practice (119, 56.1%) and at a national level (148, 69.8%). Inappropriate empirical therapy (101, 47.6%) and excessive use of antimicrobials in healthcare settings (66, 31.1%) were believed to be the main contributors to increasing bacterial resistance. Respondents favor treating infection rather than colonization (98, 46.2%), and physician education (74, 34.9%) as the most effective interventions to reduce antimicrobial resistance. Many respondents (95, 44.8%) do not feel confident in their knowledge of antimicrobial prescribing. Two-thirds of the respondents (135, 63.7%) have local antimicrobial guidelines, of which 90 (66.7%) felt were useful. Most respondents (160, 75.5%) considered their local infectious diseases service to be very helpful. CONCLUSION There are considerable unmet training and education need for physicians in the area of antimicrobial prescribing. Local antimicrobial guidelines need revision to ensure they are more relevant and helpful for medical practitioners.
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Affiliation(s)
- Abeer M Baadani
- Division of Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Anand N, Nagendra Nayak IM, Advaitha MV, Thaikattil NJ, Kantanavar KA, Anand S. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India. Indian J Crit Care Med 2016; 20:274-9. [PMID: 27275075 PMCID: PMC4876648 DOI: 10.4103/0972-5229.182200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Nikhilesh Anand
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - I M Nagendra Nayak
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - M V Advaitha
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Noble J Thaikattil
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Kiran A Kantanavar
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Sanjit Anand
- Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India
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Shridhar DP, Anitha KB, Rai M, Fernandes A. Reserve drug indent form and its impact on antimicrobial consumption and sensitivity pattern in the medical intensive care unit of a tertiary care hospital. J Clin Diagn Res 2015; 9:FC05-9. [PMID: 25859466 DOI: 10.7860/jcdr/2015/10974.5593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES A world without effective antibiotics is a terrifying but a real prospect. Overuse or misuse especially of newer and higher antimicrobials (AM) is of particular concern, as this contributes to development of resistance among microorganisms. To check this trend, the Reserve Drug Indent Form (RDIF) was introduced in our hospital and its impact on AM consumption, cost of therapy and the sensitivity pattern was studied in the medical intensive care unit (MICU). MATERIALS AND METHODS A retrospective descriptive study in the medical ICU of a tertiary care hospital from July 2012 to August 2013. From March 2013, RDIF was made mandatory to be filled up prior to prescribing reserve antimicrobials. AM consumption (expressed as DDD/100 bed days) and sensitivity pattern (expressed in percentage) six months prior to and six months after implementation of the form were analysed. RESULTS The total Reserve AM consumption was 125.79 per 100 bed days during the study period. Average occupancy index was 0.50 and length of ICU stay was 6 days. The total consumption reduced from 85.55/100 to 40.24/100 bed days after the introduction of the RDIF. However, Imipenem usage increased from 11.35/100 to 23.94/100 bed days, which can be attributed to sensitivity profile to Imipenem (82.1%) compared to Meropenem (65.7%). Cost of therapy reduced from Rs 6,27,951 to 4,20,469. CONCLUSION Reserve AM consumption showed a declining trend after introduction of the RDIF. Hence, the RDIF served as an important tool to combat inappropriate use, reducing the cost burden and also helped to improve the sensitivity to reserve drugs.
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Affiliation(s)
- Deepthi P Shridhar
- Postgraduate, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - K B Anitha
- Professor, Department of Microbiology & Co-ordinator HICC, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - Mohandas Rai
- Professor and Head, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - Anisha Fernandes
- Clinical Microbiologist (HICC), Department of Microbiology, A.J. Institute of Medical Sciences and research centre , Mangalore, India
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Khan FA, Singh VK, Sharma S, Singh P. A prospective study on the antimicrobial usage in the medicine department of a tertiary care teaching hospital. J Clin Diagn Res 2013; 7:1343-6. [PMID: 23998062 DOI: 10.7860/jcdr/2013/6265.3125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/17/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As we know, some of the species of animals are endangered, as there is an increase in their declining rate and a decrease in their survival rate. The same is true for the antibiotics also, as there is a rise in the antimicrobial resistance and a decline in the development of new antibiotics. Antimicrobial Resistance (AMR) has become a major obstacle in the way of the treatment of infectious diseases worldwide. Therefore, to fight against AMR, antibiotic utilisation studies are being carried out. Therefore, with the same perspective, this prospective study was done to evaluate the current usage of the anti-microbial agents in medicine department of a teaching hospital in northern India. METHODS This was a prospective study which was done for a period of three months from Nov 2012 - Jan 2013. The prescriptions and the patient records are reviewed and analysed. The rationality of the drug usage was also evaluated by analysing the drug prescriptions. RESULTS Out of the 494 drugs which were prescribed to 180 patients, 291 were antibiotics. The most commonly used AMAs were the β-lactams (penicillins and cephalosporins) -n = 102, followed by the quinolones -n = 93, Nitroimidazoles -n = 43, aminoglycosides -n = 35 and the macrolides -n = 18. The most common indication for the antimicrobial therapy was infection. According to the evaluation, the use of the antimicrobial therapy was found to be rational in 77.77 per cent patients. The average number of antibacterial agents which were prescribed per patient per course was found to be 1.61 and the average numbers of drugs which were prescribed per patient were 2.74.The average cost per prescription per day was Rs.115 and the average antibiotic cost per encounter was Rs. 85. CONCLUSION Antibiotic resistance is increasing at an alarming rate due to the irrational prescribing habits of physicians, leading to increasing morbidity, mortality and treatment costs. Therefore, the medical professionals as well as government personnel who are related to the health sector, need to understand that antibiotics are precious and finite resources. The remedy of this situation requires that regular educational awareness programmes should be conducted in hospitals at a regular basis.
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Affiliation(s)
- Farhan Ahmad Khan
- Associate Professor, Department of Pharmacology, Teerthanker Mahaveer Medical College & Research Centre , TMU, Moradabad, India
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Ilić K, Jakovljević E, Skodrić-Trifunović V. Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare. Eur J Pediatr 2012; 171:767-77. [PMID: 21987082 DOI: 10.1007/s00431-011-1592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
The most prevalent childhood bacterial infections in primary healthcare are respiratory, gastrointestinal and urogenital infections. The main aim of this paper was to consider factors (socio-economic factors and irrational antibiotic use) that contribute to the development of bacterial resistance, as well as measures that resulted in a reduction of this problem. Computerized search through the Medline of published articles on antibiotic resistance from 1996 to 2011 in English or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/antibiotic and resistance/susceptibility in pediatric/children, and Streptococcus pneumoniae/Streptococci/Haemophilus influenzae/Salmonellae/Escherichia coli/Shigella/Staphylococcus aureus as well as antibiotics/antimicrobials/antibacterials and consumption/utilization/use. In many developing countries, antibiotic dispensing and its use in medicine, cattle breeding and agriculture are inadequately regulated, or existing laws are not being appropriately implemented. In addition, human travel contributes to antimicrobial drug resistance around the world. All of these factors have led to a very high level of bacterial resistance. On the contrary, in countries with a clearly defined and implemented legal framework concerning antibiotic prescribing, dispensing and utilization, the use of antibiotics is under constant surveillance. That resulted in a significantly lower antibacterial resistance. In conclusion, bacterial resistance could be reduced by the implementation of systemic and long-term measures at a country level as well as at all levels of healthcare. In order to reduce bacterial resistance, antibiotic use needs to be precisely regulated, and regulations should be coherent with practice. The international community must have a more active role in solving this global problem.
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Affiliation(s)
- Katarina Ilić
- Department of Pharmacology, School of Pharmacy, University of Belgrade, PO BOX 146, Vojvode Stepe 450, 11221, Belgrade, Republic of Serbia.
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Okasha D, Kassis I, Haddad S, Krivoy N. General medications utilization and cost patterns in hospitalized children. Pharm Pract (Granada) 2009; 7:54-8. [PMID: 25147593 PMCID: PMC4139757 DOI: 10.4321/s1886-36552009000100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 02/16/2009] [Indexed: 11/30/2022] Open
Abstract
Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults.
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Affiliation(s)
- Doaa Okasha
- Clinical Pharmacology Institute, Rambam Health Care Campus. Haifa ( Israel )
| | - Imad Kassis
- Senior Physician in Pediatric and Infectious Diseases, Pediatric Infectious Diseases Unit, Meyer Pediatric Hospital, Rambam Health Care Campus. B. Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa ( Israel )
| | - Salim Haddad
- Chief Pharmacist and Director of the Central Pharmacy, Pharmacy Services, Rambam Health Care Campus. Haifa ( Israel )
| | - Norberto Krivoy
- Senior Physician in Medicine and Director of the Clinical Pharmacology Institute, Rambam Health Care Campus. B. Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa ( Israel )
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