From thetotal cephalosporins prescribed for 370 patients, 240 (64.9%) patients wereadministered cephalosporins empirically, 110 (29.7%) for definitive purposesand 20 (5.
4%) patients were prescribed cephalosporins as prophylactic therapy.In this study, hospitalization period of patients who received single or twoantibiotics together were similar but the hospitalization period of patientsreceiving three antibiotics was longer. The median length of hospital stay was5 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 44cases only.By interpreting thedata collected during the study, it was seen that the third generationcephalosporins (98.
4%) were commonly prescribed followed by the secondgeneration. class of cephalosporins. Ceftriaxone (93%) was found to be the mostcommonly prescribed third-generation cephalosporins with a daily dose of 2 gmin parenteral form. The mean duration of treatment with cephalosporins wasfound to be 4.87 days (range 1-7 days).The most common indication forcephalosporins 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 prescriptionswere analyzed by using WHO core indicators for usage pattern as shown in Table2.
The average number of overall antibiotics and cephalosporins per encounterwas found to be 1.6 and 1 respectively. The percentage of cephalosporinsprescribed in comparison to other antibiotics was found to be 63.
7%.Theparenteral administration of overall antibiotics was found to be 68.8% of which88.6% were cephalosp0orins.
Table 3 shows theDDD/100 bed-days of cephalosporin antibiotics with ATC codes as a whole and ofindividual cephalosporins in general medicine ward. The overall utilization pattern of cephalosporins inpatients was found to be 4.95 DDD/100 bed-days of which, third-generationcephalosporins were commonly used (4.88DDD/100 bed-days).Table 4 shows thecompliance of cephalosporin therapy with the antibiotic policy. The evaluationof indication, dose, duration and frequency of administration of cephalosporinstreatment according to the hospital’s antibiotic policy make known that from atotal of 370 patients, 204(55.
1%) were compliant, whereas 92(24.9%) were notaccording to the antibiotic policy, and the rest 74(20%) of the data was notmentioned in the antibiotic policy.DISCUSSION:Cephalosporins are themost widely used class of antibiotics that need careful monitoring to ensuretheir rationale use in this era where there is an increased threat due tomicrobial resistance.
6 The present study shows the marginallyhigher utilization of cephalosporins in general medicine (63.7%) which was similar to the studies reported by Gururajaet al 6 and Reddy et al8where most of thestudy patients belonged to medicine department. Gender wise distribution ofinpatients shows that cephalosporin use in femalepopulation (54.6%) was more than male (45.4%) in general medicine. This may bedue to the fact that women are more susceptible towards bacterial infections,especially UTI’s, and Respiratory tract infections.
This is similar with theresults obtained in Sri Ramachandra Hospital, Chennai which shows a femalepredominance (61.8%) over male(38.2%) population.14 Whereas,various studies have reported that cephalosporin use in the male population ismore as compared to female. 8,15,19,20 Thepresent study revealed that 240 patients (64.9%) received cephalosporins asempirical prescriptions.
Antimicrobial resistance growth rate aggravatedrapidly due to the exaggerated empirical antibiotic prescribing pattern as themicrobiological results cannot be availed within 24-72hrs.The initial therapyis started on the basis of physician’s clinical judgment, patient’s clinicalcondition, and laboratory parameters. This is similar to the studies conductedat a University hospital in West Indies 17, where two-thirds ofthe patients (67.
9%) were treated with empiric antibiotics and Babu et al16 where 74.26% was ofempiric therapy. In this study, it was observed that 29.7% of patients wereprescribed cephalosporins on the basis of culture results and confirmatorydiagnostic tests. In many cases, no microbial growth was detected; this may bethe reason for the low percentage usageof cephalosporins for the definitive therapy.
In the study, the bacteriological investigation was done only on 158 (42.7%) patients.In our hospital setting, the bacteriologicalinvestigation was not routinely performed due to the non-affordability orfinancial issues, unreliable culture results, prior initiation of therapeuticantibiotic regimen and delay in attaining the results (average of 3 days) whichexceed the length of stay and was doneonly in conditions like unresponsiveness of patients to the therapy or severeinfections.
The findings were similar to the studies conducted at the TikurAnbessa specialized hospital 21 anduniversity hospital of West Indies 17, where culture reports tooka mean of 3 and 3.7 days to become available. Certainfactors such as drug or host-related response pertaining to antibiotic therapymay lead to the failure of treatment. The number of antibiotics use may lead to an increment in treatment costincurring a financial loss due to increased length of stay in hospitalizedpatients.5 In our study, the hospitalizationperiod of a patient who received threeantibiotics was high (9.62 ± 3.96) in medicine wards; this may increase thehospital infection risk and treatment cost.
This was similar to the studyconducted in Turkey 5 wherethe use of three antibiotics was inappropriate and the incidence of hospitalstay was twice in patients leading to cost increment.