There are certain researches that have been made aboutpattern of antibiotics usage in a hospital by professional individuals orauthorised organizations and government. As eloquently stated by one of theprospective survey done in six Ministry of Health general hospitals in Malaysiain 1990, study on “Pattern of Antibiotic Usage in Hospitals in Malaysia”, aprospective, descriptive and cross-sectional survey of antibiotic prescriptionsdischarged for inpatients at six public government-run hospitals located acrossthe country, an overall of 1,918 antibiotics prescription were obtained andanalysed for pattern and trend of usage. The hospitals of which the survey hadtaken place have a vast number of beds available for inpatient patients rangingin size from 800 to 1,000 beds (Lim, Cheong, & Suleiman, 1993).Sample unit for this prospective study was an antibioticprescription whether the prescriptions was discharged for single agent alone ora combination of multiple antibiotics. Target size of 350 prescriptions foreach hospital was fixed and prescription collection was to gather from severaldepartments as such; medicine (100), surgical department (100), obstetrics andgynaecology (50), paediatrics (75) and intensive care unit (25). Eachdepartment was demanded to organise data collection for every successiveantibiotic prescriptions from a selected date until the target number ofprescriptions was collected.
It wasdiscovered that about two-thirds of 1,918 antibiotics prescriptions wereintended for therapeutic purposes while 20% of stated therapeutic prescriptionswere based on microbiological test results. A total of 661 (36%) prescriptionscame directly from medical departments while 669 (35%) came from surgicaldepartment (which include general surgery, orthopaedics, otorhinolaryngologyand ophthalmology), 344 (18%) were discovered from paediatrics clinics and 214 (11%from obstetrics and gynaecology (Lim et al., 1993).A certain number of 34 different antibiotics per se orin 136 various combinations were prescribed. These comprised of 7 grouppenicillin, 5 group cephalosporin, and 4 group aminoglycosides and 2 grouptetracycline.
Out of these, they were about 1063 (55%) single antibioticprescriptions and 855 (45%) prescriptions of different combination antibiotics.In 705 (37%) of those, the prescriptions included two group of antibiotics; in132 (7%), while precisely three antibiotics were prescribed and in 18 were morethan 3 antibiotics. Of all 34 antibiotics, ampicillin was the most frequentantibiotic given to patient, being prescribed for as much as 798 (42%)prescription. The intention of prescribingantibiotics for therapeutic purpose was in 1263 (66%) prescriptions and 614(32%) prescription for prophylactic purpose. Prophylactic antibioticsprescriptions were regularly discovered in surgical and obstetrics andgynaecology departments (Lim etal., 1993).Additionally, as mentioned before,there were only 255 (20%) of the 1263 therapeutic prescriptions which werebased on microbiological test results.
The microbiological tests which were performedinclude cultures in 240 instances and serological test in 9 prescriptions. Only 743 (59%) prescriptions involved taking culture priorto treatment. About 131 (13%) of the 1008 prescriptions, the prescribers wereincapable to identified the specific infection-induced pathogen. Furthermore,about 614 (32%) prescriptions were intended for antibiotic prophylaxis. Prophylacticantibiotics prescriptions were regularly found from surgical and obstetrics andgynaecology departments. Correspondingly, prescriptions for antibioticsprophylaxis were more often involved combinations of antibiotics. However,there was certain number of prescriptions which was about 41 which theirpurpose was not specified. Inconclusion, antibiotics and antibiotics regiments employed in the study haveshown a great variability in general.
The study identified several evidences oflack of compliance with guidelines on antibiotic use implemented by theMinistry of Health in Malaysia (Lim et al., 1993).There is also a study done inLebanon which relates to pattern of antibiotic usage, study on “Community Usage Pattern of Antibiotics within Lebanese Population: A ProspectiveStudy” by MalakKhalifeh¹’², Nicholas Moore¹, and Pascale Salam² in Lebanon (¹University deBordeaux, Bordeaux, France.
, ²Clinical & Epidemiological ResearchLaboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon). Thisstudy seeks to discover the usage pattern of antibiotics in Lebanon. Theprospective study was established in a community-based pharmacy setting inLebanon, using an organised random interview for patients that came tocommunity in search of antibiotics. Standard characteristics and reasoning fortaking self-medication were obtained while the usage pattern for the researchwas described using Anatomical Therapeutic Chemical Classification/DefinedDaily Doses (ATC/DDD) system (Khalifeh, Moore, and Salameh, 2017). The total participants in this study wasabout 501, with the female being a majority as much as 69.5% of the total.Among these participants, 314 (62.7%) demanded antibiotics withoutprescriptions for their treatment while 187 (37.
3) had a prescription for theantibiotics. The most consumed antibiotic was Amoxicillin-clavunic acid(coamoxiclav) (33.7%) as cephalosporin (21.
2%) followed behind. Besides that,the most common dispensed antibiotic without prescription was also coamoxiclav(37.3%) while followed by cephalosporin (21%), penicillin (17.2%), macrolides (6.1%)and fluoroquinolones (3.8%) correspondingly. On the other hand, the antibioticsallotted with prescription were as the following ascending order: penicillin(5.
3%), macrolides (14.4%), fluoroquinolones (17.6%), cephalosporin (21.4%) andcoamoxiclav (27.8%). On a side note, 170 (33.9%) participants disclosed theyused antibiotics once annually.
The mean for dispensation of antibiotics was9.07 DDD for short term use which is less than fortnight (<2weeks). The meanof request per year was 3.35 which were significantly higher in patientswithout medical prescription than with prescription. Group of males weredispensed with more DDDs than group of females although the significant of theresult was not high. Moreover, 25-50 years old patients had significantly takenand consumed more than 1 DDD daily (61.
7%) unparalleled to patients with agehigher than 50 years old (41%). Inconclusion, the study reveals that usage and consumption of antibiotic inLebanon is not controlled, educational awareness programs should be executed toprevent unnecessary use and misuse of antibiotics (Khalifeh et al., 2017). Additionally, we take another look on studyof antibiotic prescription pattern within Ghanaian population surroundingUniversity of Cape Coast Hospital, Ghana. The study on “Antibiotic PrescriptionPattern in a Ghanaian Primary Health Care Facility” by James Prah¹, JosephKizzie-Hayford¹, Emmanuel Walker¹, Adelaide Ampofo-Asiama¹ in Ghana(¹Universityof Cape Coast Hospital, University of Cape Coast, Ghana).
This study isconducted to assess the pattern of antibiotic prescriptions and discover theuse of standard treatment guidelines (STG) by health care practitionersprimarily clinicians. The method of this prospective cross sectional study havemade use indicators of seven core drugs that involved five prescribing and twopatient care indicators . Sample size of this study was 388 voluntaryparticipants who were recruited at outpatient pharmacy in the hospital (Prah,Kizzie-Hayford, Walker, Ampofo-Asiama, 2017). A figure of 388 patients with average age of32.
8 ~ 20.6 years old were involved in the study, 151 (39%) were males whilethe rest 237 (69%) were females. Out of all collected medical prescriptionsissued to the patients, the study explored that 55.2% of the prescriptions containedprescribed antibiotics and the mean of number of medicines per prescriptionswas 3.
5, with amoxicillin (22.5) being the most prescribed antibiotics followedby ciprofloxacin (18.4%) and coamoxiclav (13.9%) (Prah et al., 2017). There was significant association between theknowledge of patients regarding their medication and the number of drugs perprescription (p = 0.002), age (p = 0.
015) and educational level (p = 0.001).However, there was no significant association between sex of patients and theirunderstanding of medications (p = 0.902). The study mentioned that a number of40 (10.3%) patients we referred to perform test for diagnosis whilst 27 (12.6%)of the 214 patients who received antibiotics prescription were asked to performinvestigations to confirm bacterial-induced infections.
Most of the indicationantibiotics prescription issued to patients were upper respiratory infections(29.9%), followed by urinary tract infections (19.6%), dental conditions(10.
3%) and enteric fever (8.9%) (Prah et al., 2017). To sum up, the study concluded there ispractice of polypharmacy and unreasonable drug use among prescribers thereforethe pattern of antibiotics prescriptions analysed in the study was found to begenerally not satisfactory.
It is alsoknown that there were recurrent use of antibiotics by clinicians and number ofmedications prescribed per encounter which is 3.5 which slightly above theideal WHO standard of less than 2. This study may provide baseline data forothers studies that may relate to investigation of why there is polypharmacyand recurrent antibiotics usage in the hospital pharmacy setting (Prah et al., 2017).Following, there is one otherresearch made a couple of years ago on investigating pattern of antibioticsprescribing in a tertiary care hospital setting.
The research on “Patterns ofAntimicrobial Prescribing in a Tertiary Care Hospital in Oman” by AbdulrahmanAl-Yamani¹, Faryal Khamis², Ibrahim Al-Zakwani³, Hamed Al-Noomani?, JaleelaAl-Noomani? and Seif Al-Abri²(¹Internal Medicine Resident, Oman MedicalSpecialty Board, Muscat, Oman.,²Department of Internal Medicine, RoyalHospital, Muscat, Oman., ³Department of Pharmacology and Clinical Pharmacy,Sultan Qaboos University, Muscat, Oman., ?Department of Pharmacy, RoyalHospital, Muscat, Oman.
, ?Department of Nursing, Royal Hospital, Muscat, Oman.).The objectives of the study are to measure and make improvement of theantimicrobial utilisation so that optimal clinical outcomes can be achieved aswell as reducing bacterial resistance. Subsequently, the aim of this study isto evaluate antimicrobial prescribing pattern for inpatients in acute care setand also review the relevance of antimicrobial usage among prescribers in a hospitalsetting in Oman.Method of the study implementedis conducting a retrospective audit of the relevance of prescribingantimicrobials to inpatients in acute care set in tertiary care hospital inOman for a period of four-week from 1 November to 28 November 2012). Therecords of discharged patients were collected from the department databases inthe hospital. Patients’ data and medical prescriptions were evaluated by aconsultant of infectious disease.
The relevancies of antimicrobial use wasreviewed, analysed, and adjudicated based on local standard guidelines andknowledge of the consultant (Al-Yamani, Khamis, Al-Zakwani, Al-Noomani,Al-Noomani and Al-Abri, 2015).Results in the study revealsthere were about 178 patients who discharged from acute care medical teamsduring the period. One hundred and fourteen (64%) patients received a figurenumber of 287 antimicrobial drugs during admittance to acute care wards. Themean of antimicrobials prescribed per encounter was 2.
5 to 1.1. The mostfrequent antimicrobial drugs issued in prescriptions werepiperacillin/tazobactam (21.8%) followed by both amoxicillin-clavunic acid andclarithromycin (19.5%). Piperacillin/tazobactam was regularly prescribed forcommunity-acquired pneumonia (CAP), urinary tract infection (UTI), wound-siteinfection and others. Out of the 287 antimicrobial agents, 87 (30.
3%) wereindicated for CAP per se followed by UTI (13.9%). Cultures were collected aheadof time before issuing antimicrobial prescriptions in 25% of infection. Most ofthe infections were caused by gram-negative bacteria and beta-lactamaseproducing organism. Inconsistency in selection of antimicrobial for typicalinfections was observed and noted.
Succinctly, 114 (64%) patients had beengiven antimicrobial treatment during admission. Antimicrobial agents wereprescribed empirically by prescribers before culture results become available,only 12% of antimicrobial treatments were adjusted accordingly after theresults were obtained. The study has recognised a need for national guidelinesfor better management of regular infections so that inappropriate overuse andmisuse of antimicrobial medications in tertiary care hospitals can be reduced (Al-Yamaniet al.,2015).