REVIVAL OF LOST TREASURES: AN ANALYSIS OF INFREQUENTLY PRESCRIBED ANTIBIOTICS WITH THEIR EMERGING SENSITIVITY PATTERNS

Abstract

Antibiotic resistance is the alteration in bacteria to resist antibiotics that used to inhibit their growth or kill them. It’s one of the leading causes of global mortality. Reduction in antibiotic resistance is observed in bacteria in an antibiotic free environment through mechanisms like phenotypic reversion (1). It requires around $1 billion and 10-15 years to develop an antibiotic, whereas reusing older antibiotics would cost significantly lesser. Thus, this study  was done to find the relationship between infrequently prescribed antibiotics in Inpatient Departments (IPD) of a tertiary care hospital & their corresponding antibiotic sensitivity status. This was an observational, retrospective and cross-sectional study. For February 2021, antibiotic data was obtained from IPD prescription records and antibiotic sensitivity results were collected from Antibiotic Sensitivity Testing (AST) method via Kirby Bauer Disc Diffusion records in Microbiology department. The proportions of antibiotics prescribed in IPDs and AST results of antibiotics as per bacterial isolates such as Gram negative bacilli (GNB), Gram positive cocci (GPC) and Non-fermenters (NF) were expressed as percentages. Cumulative frequency cube root method was used to set cut-off frequency for infrequently and most prescribed, sensitive and resistant antibiotics. These antibiotics were tabulated along with their sensitivity patterns to compare them. A p value < 0.05 was considered as statistically significant. The study collected data from 194 IPD prescriptions and 196 patient samples. The most frequently prescribed antibiotic was ceftriaxone and least prescribed ones included chloramphenicol, nitrofurantoin, doxycycline and levofloxacin [each - 1[0.4%]). Commonly resistant antibiotics against GPC were norfloxacin (59[93.7%]), co-trimoxazole (48[76.2%]) and ampicillin (50[70.4%]) and against GNB were ampicillin (90[90%]) and ceftazidime (4[75%]). Least prescribed antibiotics with the least resistance included polymixin B & imipenem (GNB & NF), chloramphenicol (GNB) and nitrofurantoin & gentamicin (GPC & GNB). Infrequently prescribed antibiotics also had reduced resistance like nitrofurantoin (GPC & GNB) and chloramphenicol (GNB). Few most prescribed antibiotics were found to be frequently resistant as cephalosporins like ceftriaxone (GNB) and extended spectrum penicillins like piperacillin-tazobactum (NF). Amidst the evolving antibiotic sensitivity trends, this knowledge is vital for effective treatment of bacterial infections and appropriate implementation of antibiotic stewardship programs.