Publication: Antimicrobial utilization pattern in out patient services of ENT department of tertiary care hospital of Eastern Nepal
Date
2005
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Objective
The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care
hospital of Nepal.
Materials & Methods
A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the
year2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also
contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding
the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and
details of any concomitant medications.
Results
The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled
prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. .The AMAs were
indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for
more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in
32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI-
32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis
(3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in
42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture
sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The
common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%),
Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected
organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci
& pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%).The use
of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin
(23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%),
doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%),
roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to
amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin
(46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin)
Conclusions-Majority of patients were prescribed drugs irrationally with misleading indications without confirming
the bacteriological culture and sensitivity.
Keywords: AMAs (Antimicrobial Agents), URTI (upper respiratory tract infection), Drug utilization