A study of prescribing pattern of antibiotics in a tertiary care hospital using world health organiation prescribing indicators- a retrospective cross-sectional study

Background : Antibiotics are one of the most important discoveries in the field of medicine and are widely used against infectious diseases. In developing countries like India, the antibiotics are the highly consumed medicines, and irrational use of antibiotics is a common practice. Misuse of antibiotics has become even more during COVID-19 pandemic. Understanding the prescription pattern of antibiotics is crucial in tackling irrational prescription and antibiotic resistance. Objectives: 1)To study the prescription pattern of antibiotics. 2)To compare prescription pattern with WHO indicators. Methods and Methodology: A retrospective, cross-sectional study.Total of 600 precrisptional data were studiedin the department of General medicine in a tertiary centre,Tirupathi,on in-patient basis. Inclusion Criteria:1)Prescriptional data of study sample with the age group greater than 18 years of both males and females.2) Prescriptions of common infectious diseases such as enteric fever, malaria, dengue ,Acute gastro-enteritis, Pyrexia of unknown origin, URTI, LRTI, dysentry has been included .3) Prescriptions with diagnosis. Exclusion criteria:1) Prescription papers in which the handwriting of prescriber was illegible to identify medication clearly.2) Prescription papers that did not contain medication.3)HIV/HbSAg /TB /Auto-immune diseases.4)Chronic renal disease (CKD).5)Cancer. Study Method: A total of 600 prescription papers were studied. Specific prescriptions papers were selected randomly.A detailed checklist containing patient-related information, medication related with diagnosis has been prepared.WHO prescribing indicators with their standard values were utilised to measure rational use of drugs with due focus on antibiotic prescribing patterns with study period of 6 months.No culture and sensitivity tests are done before starting antibiotics. Approval of Instituitional ethics committee has beentaken before starting the study. Results: Socio-demographic characteristics have been recorded prior to the study. Drug dose, frequency of administration, route of administration, duration of treatment have been recorded. WHO-prescribing indicators :1)Average number of drugs per encounter is 4.2.(optimal value 1.6-1.8).2)Percentage of encounter with antibiotics is 126.1%(optimal value 20.0-26.8%) 3)Percentage of encounter with injectionsis 94.33%(optimal value 13.4-24%).4)Percentage of drugs prescribed by generic name is 100%(optimal value 100%).5)Percentage of drugs from Essential medicine list is 100%(optimal value 100%). Frequently prescribed antibiotic injectable was CEFTRIAXONE constituting 49.2% Conclusion: Our study concluded that prescribing pattern of antibiotics deviates from and is non-complaint with standard endorsed the WHO.“SUPERBUG-infections” are great threat to the world, due to irrational use of antibiotics.This problem may be reduced by developing an ANTIBIOTIC STEWARDSHIP PROGRAMME, introducing practice of antibiotics with the aid of culture and sensitivity tests and developing institutional guidelines.