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Published on: August 30, 2018
Estimating antibiotics consumption in a tertiary care hospital in Islamabad using a WHO's defined daily dose
Naila Jabeen1, Waseem Ullah2, Javeria Khalid3
1Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Background:
Antibiotics have helped to reduce the incidence of common infectious diseases in all modern healthcare systems, but improper use of antibiotics including their overuse and misuse can change the bacteria so much that antibiotics don't work against them. In case of developing imposable selective pressure with regard to the proportion of hospitalized patients who receive antibiotics, the quantity of antibiotics that are prescribed to them, and the proportion of patients who receive antibiotic treatment is one of the major contributors to the rising global health issue of antimicrobial resistance. Concerning the levels of antibiotic consumption in Pakistani hospitals, there is negligible research data available.
Aim:
This study aimed to evaluate five-year inpatient antibiotic use in a tertiary care hospital in Islamabad using the World Health Organization (WHO) Recommended Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology.
Method:
It was a descriptive study involving a retrospective record review of pharmacy records of antibiotics dispensed (amount in grams) to patients across different specialties of the hospital from January 2017 to December 2021 (i.e., 60 consecutive months). The antibiotic consumption was calculated by using the DDD/100-Bed Days (BDs) formula, and then relative percent change was estimated using Microsoft Excel 2021 edition.
Result:
A total of 148,483 (77%) patients who received antibiotics were included in the study out of 193,436 patients admitted in the hospital. Antibiotic consumption trends showed considerable fluctuations over a five-year period. It kept on declining irregularly from 2017 to 2019, inclined vigorously in 2020, and then suddenly dropped to the lowest DDD/100 BDs value (96.02) in the last year of the study. The overall percentage of encounters in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the WHO standard reference value (< 30%). WATCH group antibiotics were prescribed (76%) and consumed more within inpatient settings than Access (12%) and Reserve (12%) antibiotics.
Conclusion:
The hospital antibiotic consumption data is well maintained across different inpatient specialties but it is largely non-aligned with WHO AWaRe (Access-Watch-Reserve) antibiotics use and optimization during 2017-2021. Compared to the WHO standard reference figure, the overall percentage of antibiotics encountered was higher by about 47%. Antibiotic consumption trends vary with a slight increase in hospital occupancy rate, with positive relative changes being lower in number but higher in proportion than negative changes. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence.
Insights
Antimicrobial resistance is a growing concern. This study found high antibiotic prescribing rates (77%) in a Pakistani hospital, significantly exceeding WHO standards and showing poor alignment with the AWaRe classification system.
Area of Science:
- Healthcare Management
- Infectious Disease Epidemiology
- Pharmacology
Background:
- Improper antibiotic use drives antimicrobial resistance, a critical global health issue.
- Pakistan has limited data on hospital antibiotic consumption.
- Selective pressure from antibiotic use in hospitals contributes to resistance.
Purpose of the Study:
- To evaluate inpatient antibiotic utilization over five years in a tertiary care hospital in Islamabad.
- To apply the World Health Organization's Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology.
Main Methods:
- Retrospective review of pharmacy dispensing records from January 2017 to December 2021.
- Calculation of antibiotic consumption using the DDD/100-Bed Days (BDs) formula.
- Analysis of trends and relative changes in antibiotic use.
Main Results:
- Antibiotic consumption showed significant fluctuations, declining from 2017-2019, increasing in 2020, and dropping in 2021.
- 77% of admitted patients received antibiotics, far exceeding the WHO standard of <30%.
- WATCH group antibiotics constituted the majority (76%) of prescribed and consumed antibiotics.
Conclusions:
- Hospital antibiotic consumption data exists but is not aligned with WHO AWaRe guidelines.
- Prescribing rates were substantially higher than WHO benchmarks, indicating suboptimal antibiotic stewardship.
- Despite an existing policy, adherence to antibiotic guidelines appears low.
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