Antibiotic Utilization in General Medical Units in a Tertiary Care Institution

Abstract

Objectives: To ascertain the use and appropriateness of antibiotics used in medical wards at a selected tertiary care institution using available national guidelines

Methods: A descriptive cross sectional study was carried out on the patients prescribed antibiotics in three general medical units. A random sample of patient records (n=543) over a period of 4 months was analyzed. The regimes were assessed for concordance with the guidelines of Sri Lanka Medical Association (SLMA) and the Health Sector Development Programme (HSDP).

Results: The commonest indications to prescribe antibiotics were lower respiratory tract infections (LRTI) (n=235, 43%) and urinary tract infections (UTI) (n=60,11%). The commonest first antibiotic prescribed for LRTI was co-amoxiclav (n=98, 41.7%) which was given in combination in 18/98 (18.36%) of episodes, while ciprofloxacin was the first choice in 46.6% of UTls. For LRTls the prescribed antibiotics showed a greater concordance with HSDP guidelines (n=157, 66.8%) compared to SLMA guidelines (n=99, 42.1%).The concordance with SLMA guidelines for UTls was only 23.3% (n=14). No statistically significant difference was found between individual unit practices. The antibiotic use in LRTI was incorrect due to inappropriate dose and route of the drug (n=20,8.5%),wrong choice of the drug (n=13,5.5%) and wrong combination of drugs (n=13,5.5%) according to the HSDP guidelines.

Conclusions: Antibiotic prescriptions need to be improved to optimize use and reduce development of resistance. Development and effective implementation of a National Antibiotic Policy would be a major step in ensuring appropriate use of antibiotics.