PATTERNS AND PREDICTORS OF ANTIBIOTIC PRESCRIBING IN OUTPATIENT CARE: A CROSS-SECTIONAL STUDY FROM A TERTIARY HOSPITAL IN INDIA
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Keywords
Antibiotic stewardship; Cephalosporins; Outpatient department; Prescription audit; Rational drug use
Abstract
Abstract
BACKGROUND: Rising antimicrobial resistance, compounded by a substantial increase in outpatient antibiotic use, particularly of broad-spectrum drugs like cephalosporins and fluoroquinolones, poses a serious public health and economic threat in India, where community consumption accounts for approximately 80% of antibiotic use and up to half of it is potentially inappropriate
OBJECTIVES: To assess the frequency and pattern of antibiotic prescriptions in the General Medicine outpatient department and evaluate demographic factors influencing prescription trends.
METHODS: A retrospective cross-sectional study was conducted over three months at a tertiary care teaching hospital, analysing 300 patient records aged 18–70 years who received at least one antibiotic. Data on demographics, prescribed antibiotic classes, number of prescriptions per patient, and associated diagnoses were extracted from pharmacy records. Descriptive statistics were applied using Microsoft Excel.
RESULTS: The mean number of antibiotics prescribed per patient was 1.61 ± 0.72. The most represented age group was 31–45 years (n = 96; 32.00%), and males comprised 174 (58.00%) of the sample. One antibiotic was prescribed to 132 (44.00%) patients, two to 105 (35.00%), three to 45 (15.00%), and four or more to 18 (6.00%). Cephalosporins were the most frequently prescribed class (n = 114; 38.00%), followed by fluoroquinolones (n = 63; 21.00%) and macrolides (n = 48; 16.00%). The primary indications included respiratory tract infections (n = 111; 37.00%), urinary tract infections (n = 69; 23.00%), and gastrointestinal infections (n = 48; 16.00%). Cephalosporins drove antibiotic spending, representing 38.20% of OPD antibiotic costs and 16.80% of total pharmaceutical expenditure. Cephalosporin use (OR = 4.26, r = 0.71) and polypharmacy (OR = 3.35, r = 0.62) were the strongest predictors of high-cost antibiotic prescriptions, whereas nitroimidazole use (r = –0.65) was associated with the lowest cost, highlighting significant variations in prescribing patterns and economic impact.
CONCLUSIONS: Broad-spectrum antibiotics were frequently prescribed in the outpatient setting, often empirically. These findings underscore the urgent need for localized antibiotic stewardship to optimize prescribing behaviors.
References
2. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.
3. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients. BMJ. 2010;340:c2096.
4. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229–41.
5. Kotwani A, Wattal C, Joshi PC, Holloway K. Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India. J Clin Pharm Ther. 2012;37(3):308–12.
6. Chandy SJ, Naik GS, Charles R, et al. The impact of policy guidelines on hospital antibiotic use over a decade: a retrospective analysis. PLoS One. 2014;9(3):e90206.
7. Kumar R, Indira K, Rizvi A, Rizvi T, Jha PC. Assessment of prescription pattern at the public health facilities of Lucknow district. Indian J Pharmacol. 2008;40(6):243–7.
8. Sharma M, Eriksson B, Marrone G, Dhaneria SP, Lundborg CS. Antibiotic prescribing in medical intensive care units—a comparison between two private sector hospitals in Central India. PLoS One. 2016;11(11):e0141929.
9. WHO. Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2020. Geneva: World Health Organization; 2020.
10. ICMR. Antimicrobial resistance surveillance network. Indian Council of Medical Research. 2023. Available from: https://main.icmr.nic.in/AMR
11. Jain M, Pandey S, Chandel RK, Thakur M. Drug utilization study of antimicrobial agents in the medicine department of a tertiary care teaching hospital in Dehradun, Uttarakhand. Natl J Physiol Pharm Pharmacol. 2019;9(8):740–5.
12. Gandra S, Kotwani A. Need to improve availability of antibiotics in public sector facilities and promote rational use in private sector. Indian J Pharmacol. 2019;51(2):74–7.
13. Gupta S, Nayak RP. A study on antibiotic prescribing pattern in the outpatient department of a tertiary care teaching hospital in South India. J Clin Diagn Res. 2016;10(4):FC01–FC04.
14. Akter SF, Jahan I, Islam MT, et al. Assessment of antibiotic prescribing pattern in outpatient departments of tertiary medical colleges in Bangladesh. J App Pharm Sci. 2021;11(10):134–41.
15. Versporten A, Sharland M, Bielicki J, et al. The antibiotic resistance and prescribing in European children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71(4):1106–17.
16. Kaur S, Rajagopalan S, Samavedam S. Antibiotic prescribing practices in outpatient departments: a cross-sectional audit from a tertiary care hospital. Indian J Pharmacol. 2021;53(2):107–12.
17. Bansal D, Mangla S, Undela K, Gudala K, D’Cruz S, Sachdev A, et al. Measurement of adult antibiotic misuse in outpatient departments in India: a multicentric study. J Infect Dev Ctries. 2020;14(3):219–26.
18. Dey S, Jain P, Saha P, Roy P. Pattern of fluoroquinolone use in a tertiary care hospital in eastern India: a prescription audit. J Clin Diagn Res. 2019;13(5):FC05–FC08.
19. Nagpal A, Roy V, Kakar A. A cross-sectional analysis of antibiotic usage in gastroenteritis in Delhi outpatient settings. Int J Infect Dis. 2022;117:123–8.
20. Sharma A, Singh S, Gautam V, Ray P. Emerging resistance to fluoroquinolones and its impact on therapy of enteric fever in India. J Antimicrob Chemother. 2018;73(10):2751–6.
21. Singh M, Shah M, Singh N. Antibiotic prescribing for upper respiratory infections in urban OPDs: are we following guidelines? Natl Med J India. 2020;33(2):98–101.
22. Kotwani A, Wattal C, Katewa S, Joshi PC, Holloway K. Factors influencing primary care physicians to prescribe antibiotics in Delhi, India. Fam Pract. 2010;27(6):684–690.
23. Sharma M, Eriksson B, Marrone G, Dhaneria SP, Lundborg CS. Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: a cross-sectional study in Ujjain, India. BMC Infect Dis. 2012;12:155.
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Dr Swapnil Srivastava
Associate professor, Department of Pharmacology, Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India
Dr Sanjog Narain Tewari
Assistant Professor, Department of Pharmacology, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh, India
Dr.Vivek Gautam
Associate Professor, Department of General Medicine, Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India
Dr. Bikash Gairola
Professor, Department of Pharmacology, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh, India
Dr Dharmender Gupta
Professor, Department of Pharmacology, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh, India
Dr Masuram Bharath Kumar
Associate Professor, Department of Pharmacology, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh, India