https://doi.org/10.4081/monaldi.2024.3196
Prescription patterns and drug utilization in respiratory tract infections: implications for antimicrobial stewardship at a tertiary care teaching hospital
Submitted: September 6, 2024
Accepted: September 26, 2024
Published: December 23, 2024
Accepted: September 26, 2024
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SUPPLEMENTARY MATERIAL: 15
SUPPLEMENTARY MATERIAL: 15
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Respiratory tract infections (RTIs) are common causes of hospital admissions and are often treated with multiple medications, including antibiotics, contributing to antimicrobial resistance. Effective drug utilization evaluation (DUE) is essential for ensuring rational drug use in RTI management. This study aimed to assess prescription patterns and drug utilization in RTI patients at a tertiary care hospital, focusing on the rationality of drug use, polypharmacy, adherence to clinical guidelines, and implications for antimicrobial stewardship. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024. Data from 200 RTI inpatients, including demographics, medication types, administration routes, and prescription patterns, were analyzed. Descriptive and inferential statistics were used to evaluate adherence to guidelines and rational drug use. DUE revealed that 50.99% of patients were not prescribed cough syrup. Oral (52%) and intravenous (48%) routes were the most common. Budesonide was the most frequently prescribed bronchodilator (26.49%), and 72.45% of patients received oxygen. Ceftriaxone (12.68%) and azithromycin (11.88%) were the most commonly prescribed antibiotics. A high prevalence of polypharmacy was identified, with 39.50% of patients receiving more than three antibiotics, raising concerns about drug interactions and rationality. The study underscores the need for stricter adherence to clinical guidelines and targeted antimicrobial stewardship in RTI management. Enhanced DUE practices could improve patient outcomes and promote rational drug use.
Fleming-Dutra KE, Hersh AL. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits. JAMA 2016;315:1864-73.
DOI: https://doi.org/10.1001/jama.2016.4151
Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T 2015;40:277-83.
Barker KN, Mikeal RL. Implementing Hepler and Strand’s framework for pharmaceutical care in a hospital setting. Am J Health Syst Pharm 2000;57:890-5.
Chisholm-Burns MA, Lee JK, Spivey CA. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010;48:923-33.
DOI: https://doi.org/10.1097/MLR.0b013e3181e57962
Pereira LR, Freitas O. A model for pharmaceutical care in Brazil. Pharm World Sci 2008;30:704-9.
Goff DA, Kullar R. A focused review of antimicrobial stewardship in the era of drug-resistant pathogens. Clin Infect Dis 2020;71:2156-62.
Laxminarayan R, Duse A. Antimicrobial resistance: a global overview. Infect Dis Clin North Am 2014;28:483-94.
Barlam TF, Cosgrove SE. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51-77.
DOI: https://doi.org/10.1093/cid/ciw118
Sullivan AH, Flanagan P. Rational antibiotic use and antimicrobial stewardship: the path forward. Eur J Clin Microbiol Infect Dis 2019;38:1115-24.
Mouton JW, Theuretzbacher U. Antimicrobial stewardship and the role of drug utilization evaluation in hospital settings. Clin Microbiol Infect 2020;26:12-9.
McGowan JE. Antimicrobial stewardship -- the state of the art in 2011: focus on outcome and methods. Infect Control Hosp Epidemiol 2012;33:331-42.
DOI: https://doi.org/10.1086/664755
Davey P, Marwick CA. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017;2:CD003543.
DOI: https://doi.org/10.1002/14651858.CD003543.pub4
Laxminarayan R, Duse A, Wattal C, et al. Antimicrobial resistance: the need for global solutions. Lancet Infect Dis 2013;13:1057-98.
DOI: https://doi.org/10.1016/S1473-3099(13)70318-9
Hiryak KM, Kludjian GA, Gallagher JC, et al. Improving antibiotic utilization through an outpatient stewardship initiative. Antimicrob Steward Healthc Epidemiol 2023;3:e120.
DOI: https://doi.org/10.1017/ash.2022.367
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589-96.
DOI: https://doi.org/10.1097/01.CCM.0000217961.75225.E9
Bianco A, Licata F, Ga Nobile C, et al. Pattern and appropriateness of antibiotic prescriptions for upper respiratory tract infections in primary care paediatric patients. Int J Antimicrob Agents 2022;59:106469.
DOI: https://doi.org/10.1016/j.ijantimicag.2021.106469
Shen J, Sun Q, Zhou X, et al. Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital. Int J Clin Pharm 2011;33:929-33.
DOI: https://doi.org/10.1007/s11096-011-9577-z
Wubben DP, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy 2008;28:421-36.
DOI: https://doi.org/10.1592/phco.28.4.421
McGowan JE Jr. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286-92.
DOI: https://doi.org/10.3201/eid0702.010228
Jee Y, Carlson J, Rafai E, et al. Antimicrobial resistance: a threat to global health. Lancet Infect Dis. 2018 Sep;18(9):939-940.
DOI: https://doi.org/10.1016/S1473-3099(18)30471-7
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-43.
DOI: https://doi.org/10.1093/ajhp/47.3.533
Steinman MA, Landefeld CS, Gonzales R. Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA 2003;289:719-25.
DOI: https://doi.org/10.1001/jama.289.6.719
Spellberg B, Gilbert DN. The future of antibiotics and resistance: a tribute to a career of leadership by John Bartlett. Clin Infect Dis 2014;59:S71-5.
DOI: https://doi.org/10.1093/cid/ciu392
Fishman N. Antimicrobial stewardship. Am J Infect Control 2006;34:S55-63.
DOI: https://doi.org/10.1016/j.ajic.2006.05.237
Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-77.
DOI: https://doi.org/10.1086/510393
Gould IM. Antibiotic policies to control hospital-acquired infection. J Antimicrob Chemother 2008;61:763-5.
DOI: https://doi.org/10.1093/jac/dkn039
Masnoon N, Shakib S, Kalisch-Ellett L, et.al. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017;17:230.
DOI: https://doi.org/10.1186/s12877-017-0621-2
Pulcini C, Wencker F, Frimodt-Moller N, et al. European survey on principles of prudent antibiotic prescribing teaching in undergraduate students. Clin Microbiol Infect 2015;21:354-61.
DOI: https://doi.org/10.1016/j.cmi.2014.11.015
Dar OA, Hasan R, Schlundt J, et al. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet 2016;387:285-95.
DOI: https://doi.org/10.1016/S0140-6736(15)00520-6
David Tell, Sven Engström, Sigvard Mölstad. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. BMJ Open 2015;5:e008096.
DOI: https://doi.org/10.1136/bmjopen-2015-008096
Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579-87.
DOI: https://doi.org/10.1016/S0140-6736(05)17907-0
Dyar OJ, Huttner B, Schouten J, et al. What is antimicrobial stewardship? Clin Microbiol Infect 2017;23:793-8.
DOI: https://doi.org/10.1016/j.cmi.2017.08.026
Islam N, Reid D. Inhaled antibiotics: a promising drug delivery strategy for efficient treatment of respiratory infections. Respir Med. 2024.
DOI: https://doi.org/10.1016/j.rmed.2024.107661
Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy. Part II: Ten questions reflecting knowledge gaps and issues of controversy in the field of antimicrobial stewardship. Ther Adv Infect Dis 2020;7:2049936120945083.
DOI: https://doi.org/10.1177/2049936120945083
Ethics Approval
The study's purpose was conveyed to the patients and their families. The patients provided written informed consent. The KLE College of Pharmacy Ethical Committee gave its approval to the study. (IEC Reference Number: KLECOPH/IEC/2023- 24/08).How to Cite
Dsouza, Princy Domnic, Sai Phalguna Prakash Chitralu, Chandrashekhar Mallikarjun Patil, Vinod Ashok Koujalagi, and Sanatkumar Bharamu Nyamagoud. 2024. “Prescription Patterns and Drug Utilization in Respiratory Tract Infections: Implications for Antimicrobial Stewardship at a Tertiary Care Teaching Hospital”. Monaldi Archives for Chest Disease, December. https://doi.org/10.4081/monaldi.2024.3196.
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