From 3 shows the DDD/100 bed-days of cephalosporin

From the
total cephalosporins prescribed for 370 patients, 240 (64.9%) patients were
administered cephalosporins empirically, 110 (29.7%) for definitive purposes
and 20 (5.4%) patients were prescribed cephalosporins as prophylactic therapy.
In this study, hospitalization period of patients who received single or two
antibiotics together were similar but the hospitalization period of patients
receiving three antibiotics was longer. The median length of hospital stay was
5 days. Bacteriological investigations were not done in most of the patients
(57.3%) to determine the aetiology of the suspected infection. Out of the 158
(42.7%) cases in which the microbial test was done, growth was observed in 44
cases only.

By interpreting the
data collected during the study, it was seen that the third generation
cephalosporins (98.4%) were commonly prescribed followed by the second
generation. class of cephalosporins. Ceftriaxone (93%) was found to be the most
commonly prescribed third-generation cephalosporins with a daily dose of 2 gm
in parenteral form. The mean duration of treatment with cephalosporins was
found to be 4.87 days (range 1-7 days).The most common indication for
cephalosporins use was for respiratory tract infections (31.9%) followed by UTI
(15.7%). In 57.8% patients co-prescribed with other antibiotics, azithromycin
(45.8%) was most commonly used.

The drug prescriptions
were analyzed by using WHO core indicators for usage pattern as shown in Table
2. The average number of overall antibiotics and cephalosporins per encounter
was found to be 1.6 and 1 respectively. The percentage of cephalosporins
prescribed in comparison to other antibiotics was found to be 63.7%.The
parenteral administration of overall antibiotics was found to be 68.8% of which
88.6% were cephalosp0orins.

Table 3 shows the
DDD/100 bed-days of cephalosporin antibiotics with ATC codes as a whole and of
individual cephalosporins in general medicine ward. The overall utilization pattern of cephalosporins in
patients was found to be 4.95 DDD/100 bed-days of which, third-generation
cephalosporins were commonly used (4.88DDD/100 bed-days).

Table 4 shows the
compliance of cephalosporin therapy with the antibiotic policy. The evaluation
of indication, dose, duration and frequency of administration of cephalosporins
treatment according to the hospital’s antibiotic policy make known that from a
total of 370 patients, 204(55.1%) were compliant, whereas 92(24.9%) were not
according to the antibiotic policy, and the rest 74(20%) of the data was not
mentioned in the antibiotic policy.

DISCUSSION:

Cephalosporins are the
most widely used class of antibiotics that need careful monitoring to ensure
their rationale use in this era where there is an increased threat due to
microbial resistance. 6 The present study shows the marginally
higher utilization of cephalosporins in general medicine (63.7%) which was similar to the studies reported by Gururaja
et al 6 and Reddy et al8where most of the
study patients belonged to medicine department. Gender wise distribution of
inpatients shows that cephalosporin use in female
population (54.6%) was more than male (45.4%) in general medicine. This may be
due to the fact that women are more susceptible towards bacterial infections,
especially UTI’s, and Respiratory tract \infections. This is similar with the
results obtained in Sri Ramachandra Hospital, Chennai which shows a female
predominance (61.8%) over male(38.2%) population.14 Whereas,
various studies have reported that cephalosporin use in the male population is
more as compared to female. 8,15,19,20

The
present study revealed that 240 patients (64.9%) received cephalosporins as
empirical prescriptions. Antimicrobial resistance growth rate aggravated
rapidly due to the exaggerated empirical antibiotic prescribing pattern as the
microbiological results cannot be availed within 24-72hrs.The initial therapy
is started on the basis of physician’s clinical judgment, patient’s clinical
condition, and laboratory parameters. This is similar to the studies conducted
at a University hospital in West Indies 17, where two-thirds of
the patients (67.9%) were treated with empiric antibiotics and Babu et al16 where 74.26% was of
empiric therapy. In this study, it was observed that 29.7% of patients were
prescribed cephalosporins on the basis of culture results and confirmatory
diagnostic tests. In many cases, no microbial growth was detected; this may be
the reason for the low percentage usage
of cephalosporins for the definitive therapy.

In the study, the bacteriological investigation was done only on 158 (42.7%) patients.
In our hospital setting, the bacteriological
investigation was not routinely performed due to the non-affordability or
financial issues, unreliable culture results, prior initiation of therapeutic
antibiotic regimen and delay in attaining the results (average of 3 days) which
exceed the length of stay and was done
only in conditions like unresponsiveness of patients to the therapy or severe
infections. The findings were similar to the studies conducted at the Tikur
Anbessa specialized hospital 21 and
university hospital of West Indies 17, where culture reports took
a mean of 3 and 3.7 days to become available.

Certain
factors such as drug or host-related response pertaining to antibiotic therapy
may lead to the failure of treatment. 
The number of antibiotics use may lead to an increment in treatment cost
incurring a financial loss due to increased length of stay in hospitalized
patients.5 In our study, the hospitalization
period of a patient who received three
antibiotics was high (9.62 ± 3.96) in medicine wards; this may increase the
hospital infection risk and treatment cost. This was similar to the study
conducted in Turkey 5 where
the use of three antibiotics was inappropriate and the incidence of hospital
stay was twice in patients leading to cost increment. 

Author: