Abstract

PATTERN OF ANTIMICROBIAL USE IN PATIENTS ON VENTILATOR IN A TERTIARY CARE HOSPITAL

ABSTRACT

Excess and indiscriminate use of antibiotics has been described both in community and hospital settings particularly in developing countries, can lead to adverse affects complicating the therapy, emergence of drug resistance and increases the cost of health care. Antimicrobial(AMA) resistance in the intensive care unit (ICU) has emerged as an important problem. It is estimated that antibiotic consumption is approximately tenfold greater in ICU than in general hospital wards. Systematic studies to generate valid information regarding the utilization of AMAs in patients on ventilator may help in improving the quality of antimicrobial use and also in formulating effective infection control strategies in the management of such patients. There is limited data on antibiotic prescription pattern in patients on ventilator from India, hence the study was done with an objective to know the antibiotic prescription pattern in patients on ventilator and to analyze rationality among the prescriptions. This was an observational study conducted in the ICU of a tertiary care hospital in South India from March 2011 to June 2011. The prescribing pattern of AMAs in patients aged between 18-65 years was studied prospectively in patients of either sex, receiving antimicrobials. Total 34 AMAs preparations were used either single or in combination. In the present study, the commonly used AMAs were beta-lactam antibiotics, particularly piperacillin+tazobactam (extended-spectrum penicillins+β-lactamase inhibitor) and metronidazole followed by ceftriaxone (long-acting third-generation cephalosporin) as single or combination therapy. Combination of AMAs was used in 85% of patients. Out of 348 drugs in the National Essential Drug List 2011, 64 drugs are grouped under anti-infective agents. In our study, out of 34 AMAs preparation 17 (50%) drugs were essential drug list and study the average number of drugs prescribed in the ICU was 8.6±4.5. Rational empiric antimicrobial therapy is essential in achieving good outcomes. There is an urgent need to implement and monitor infection control committee, based on local AMAs prescription pattern and susceptibility patterns, which help in minimizing the irrational use of AMAs.

Keywords: Antimicrobial agents, Intensive Care Unit, Rational use, Prescribing pattern.