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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 3  |  Page : 146-148

Drug utilization study on antimicrobials use in lower respiratory tract infection in Pediatric Intensive Care Unit of Rural Tertiary Care Hospital


1 Department of Pharmacology, MGIMS, Sewagram, Wardha, India
2 Department of Paediatrics, MGIMS, Sewagram, Wardha, India
3 Department of Pharmacology, 1SMBT IMS and RC, Nashik, Maharashtra, India

Date of Web Publication28-Sep-2016

Correspondence Address:
Satish E Bahekar
SMBT IMS and RC, Dhamangaon Ghoti, Ta Igatpuri, Nashik, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.191178

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  Abstract 

Background: Antimicrobial agents (AMAs) are the most commonly prescribed drugs for lower respiratory tract infections (LRTIs). This study was conducted to evaluate the pattern of prescription and AMAs use in LRTI. Aims: This study was conducted to evaluate the pattern of prescription and AMAs use in Pediatric Intensive Care Unit (PICU) for LRTIs patients of Rural Tertiary Care Teaching Hospital. Materials and Methods: This is prospective, observational study undertaken in a pediatric patient in PICU in tertiary care hospital. Prescriptions of 65 patients of age group 1-12 years diagnosed with (LRTIs) years admitted in PICU of a Rural Tertiary Care Teaching Hospital were studied. Positive blood samples were studies for common microorganisms, their sensitivity, and resistance to AMAs. Settings and Design: The study was a prospective, observational study carried out by collecting prescriptions of patients admitted in PICU diagnosed as LRTI clinically. Statistical Analysis Used: The obtained data were subjected to descriptive statistical analysis using Microsoft Excel. Results: Of 65 patients admitted in PICU of LRTI, 12 patients were of mild-moderate pneumonia, three patients were of bronchiolitis, ten patients were of croup, three patients were of bronchitis, and 37 patients were of severe pneumonia. The most frequently prescribed AMAs were a combination of cephalosporin and aminoglycosides. The most common organism isolated was streptococcus pneumonia sensitive to meropenem in 84.6%, resistant to ampicillin in 92.3%, amoxicillin in 92.3%, and cloxacillin in 92.3% of cases. Conclusions: This study has given an insight into utilization pattern of AMAs in LRTI prescribing on which future intervention studies may be based to promote rational drug use.

Keywords: Antimicrobial agents, drug utilization, lower respiratory tract infection, Pediatric Intensive Care Unit


How to cite this article:
Gajbhiye VP, Kale RS, Vilhekar KY, Bahekar SE. Drug utilization study on antimicrobials use in lower respiratory tract infection in Pediatric Intensive Care Unit of Rural Tertiary Care Hospital. J Med Soc 2016;30:146-8

How to cite this URL:
Gajbhiye VP, Kale RS, Vilhekar KY, Bahekar SE. Drug utilization study on antimicrobials use in lower respiratory tract infection in Pediatric Intensive Care Unit of Rural Tertiary Care Hospital. J Med Soc [serial online] 2016 [cited 2020 Oct 31];30:146-8. Available from: https://www.jmedsoc.org/text.asp?2016/30/3/146/191178


  Introduction Top


Lower respiratory tract infections (LRTIs) are the leading cause of deaths among all infectious diseases globally. They occur frequently and are associated with significant morbidity and mortality in children. [1] The most commonly observed LRTIs are bronchitis and pneumonia. Pneumonia is the leading infectious cause of deaths in children worldwide, accounting for 15% of all deaths of children under 5-year-old. [2] Because LRTIs are major reasons for antimicrobial agents (AMAs) utilization and changes in AMAs resistance patterns are threat to its effective treatment, there is increasing concern about AMAs prescription in community. [3] The objective of this study was to focus on the trends in the AMAs utilization, common microorganisms isolated from blood culture, sensitivity, and resistance pattern in LRTIs in children admitted to PICU of rural area.

In the recent years, studies on drug utilization have become a potential tool to be used in the evaluation of health systems. [4] Drug utilization patterns among outpatient departments are frequently monitored in many countries, but the studies on inpatient departments are rare and incomplete. Studies of drug utilization in respiratory tract infection are also low. [5] Hence, this study was planned to focus on the trends in the antimicrobial utilization in LRTIs. This information is not disease-specific but reflects overall rates and illustrates trends in utilization of AMAs in the treatment of LRTIs.


  Materials and methods Top


This study was conducted after obtaining the permission from the Institutional Ethics Committee. This was a prospective, observational study carried out by collecting prescription of patients admitted to PICU of a Rural Tertiary Care Teaching Hospital. The study was conducted over a period January 2012 to October 2014. Of total admission of 220 patients in PICU during this period, 65 patients were diagnosed as LRTI and were selected for study group. Patients of age group 1-12 years, clinically diagnosed as LRTI, who did not received any AMAs within 24 h of admission, were included. Four patients were discharged against medical advice were excluded from study. Blood samples for culture and sensitivity pattern were sent in those patients who were clinically distressed. Common microorganisms found in positive blood samples, their sensitivity and resistance to AMAs were recorded. The data collected were subjected to descriptive statistical analysis using Microsoft Excel.


  Results Top


The study evaluated the drug utilization pattern in the patients treated for LRTIs in PICU. A total number of patients in the study were 65, among which 45 were male, and twenty were females. In a total of 65 patients of LRTI, 28 cases received mono-AMAs therapy (beta-lactams) and 37 patients received combined AMAs therapy (i.e., ceftriaxone and amikacin) [Table 1].
Table 1: Distribution of antimicrobial agents in lower respiratory tract infections (n=65)

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Of 65 patients, blood samples were sent for culture and sensitivity in 49 patients diagnosed with mild to moderate and severe pneumonia. Of 49 patients, 31 samples were positive for culture report. Of 31 positive blood culture, the most common microorganisms were Streptococcus pneumonia in 13 (41.9%), followed by Pseudomonas aeruginosa in 6 (19.35%), Klebsiella pneumoniae in 5 (16.12%). Least common microorganisms were coagulase negative staphylococcus found in 2 (6.45%) and Acinetobacter found in 1 (3.22%) sample [Graph 1 [Additional file 1]].

In sensitivity pattern, it was observed that streptococcus pneumonia, the most common microorganism was sensitive to meropenem in 84.6%, vancomycin in 92.3% and resistant to ampicillin in 92.3%, amoxicillin in 92.3%, and cloxacillin in 92.3%.


  Discussion Top


This study showed predominance of male children over females as was also seen in the study done by Palikhe. [6] This can be attributable to the prevalence of gender inequality as a result of which males are preferentially taken to tertiary care unit for treatment as compared to females with similar severity of illness.

In this study, among LRTIs, pneumonia was the most common reason for PICU admission. A study done by Abramczyk et al. [7] also shows that pneumonia is a common cause of admission which is similar to this study.

Prescribing pattern of AMAs in this study shows that combined AMAs were only prescribed for severe pneumonia. These combined AMAs were from combination of cephalosporin and aminoglycosides. The results are similar as that of study done by Ilia et al. [8]

Results pertaining to microbiological profiles show that streptococcus pneumonia 13 (41.9%) being the most common organism, were sensitive to meropenem in 84.6% and vancomycin in 92.3% and resistant to ampicillin in 92.3%, amoxicillin in 92.3%, and cloxacillin in 92.3%. A study results are similar as those mentioned by Hachiya et al. [9]

In this study, the parenteral route was more common than the oral route. This is clarified by the explanation that patients admitted were in critically ill condition and most commonly prescribed AMAs were in a combination of cephalosporin and aminoglycosides, which is available in parenteral form.


  Conclusions Top


To conclude, AMAs are most commonly prescribed drugs in LRTIs, thus special measures are imperative for their rational usage to prevent the emergence of resistance. This preliminary study has given an insight into the pattern of AMAs prescribing on which future intervention studies may be based to promote rational drug use. Drug utilization studies have the potential to make objective evaluation and analysis of health professionals' work and provide them with feedback to stimulate thinking about their practice and finding ways to improve physicians' own performance. [10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chang AB, Chang CC, O′Grady K, Torzillo PJ. Lower respiratory tract infections. Pediatr Clin North Am 2009;56:1303-21.  Back to cited text no. 1
    
2.
Grant CC, Scragg R, Tan D, Pati A, Aickin R, Yee RL. Hospitalization for pneumonia in children in Auckland, New Zealand. J Paediatr Child Health 1998;34:355-9.  Back to cited text no. 2
    
3.
Wattal C, Goel N, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Surveillance of multidrug resistant organisms in tertiary care hospital in Delhi, India. J Assoc Physicians India 2010;58 Suppl:32-6.  Back to cited text no. 3
    
4.
Sachdeva PD, Patel BG. Drug utilization studies-scope and future perspectives. Int J Pharm Biol Res 2010;1:11-6.  Back to cited text no. 4
    
5.
Truter I. A review of drug utilization studies and methodologies. Jordan J Pharm Sci 2008;1:91-104.  Back to cited text no. 5
    
6.
Palikhe N. Prescribing pattern of antibiotics in paediatric hospital of Kathmandu valley. Kathmandu Univ Med J (KUMJ) 2004;2:6-12.  Back to cited text no. 6
    
7.
Abramczyk ML, Carvalho WB, Carvalho ES, Medeiros EA. Nosocomial infection in a Pediatric Intensive Care Unit in a developing country. Braz J Infect Dis 2003;7:375-80.  Back to cited text no. 7
    
8.
Ilia S, Spanaki AM, Geromarkaki E, Filippou O, Briassouli E, Fitrolaki DM, et al. Contribution to mortality and resource usage of nosocomial and community infections in an intensive care setting. Int J Med 2009;2:303-8.  Back to cited text no. 8
    
9.
Hachiya T, Kubo K, Yanagisawa H. Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa isolated in major hospitals in Nagano prefecture. Jpn J Antibiot 2004;57:157-71.  Back to cited text no. 9
    
10.
Nandimath MK, Ahuja S. Drug prescribing pattern in upper respiratory tract infection in children aged 1-14 years. Int J Pharm Bio Sci 2012;3:299-301.  Back to cited text no. 10
    



 
 
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