https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/76 Tue, 02 Aug 2016 12:19:35 +0000 A cross sectional study was conducted in inpatient department of seven primary level hospitals care centers (PLHCs) and six tertiary level hospitals (TLHs) of the country. Total 2058 hospitalized patients were interviewed over a six month period from October 2012. Most of the patients (85.9% in TLH and 100% in PLH) were prescribed with antibiotics at the time of admission. Only 6.4% patients of TLHs treated with antibiotic had culture proven infection and rest of the patient of TLH and all the patients of PLH were treated with antibiotic empirically. Top prescribed antibiotic was ceftriaxone (39.64% in TLH, 59.64% in PLH). Parenteral route of antibiotic administration was preferred for both at TLHs and PLHCs (63.3% and 76.9%). The results of the present study indicated that antibiotics were widely and inappropriately used without following standard guidelines or based on any rationality. This is an alarming situation, and needs to be addressed by the relevant authority to save the people from growing antibiotic resistance. Ibrahim Med. Coll. J. 2015; 9(2): 42-44     Medicines play an important role in health care delivery and disease prevention. The availability and affordability of good quality drugs along with their rational use is needed for effective health care. Antimicrobial agents are the most frequently prescribed drugs among hospitalized patients. However, irrational drug use is prevalent, especially in the developing countries due to irrational prescribing, dispensing, and administration of medications.1 Excessive and inappropriate antibiotic use can lead to the emergence of bacterial resistance. Resistance of common hospital-acquired bacteria to antibiotics is a worldwide problem. It can lead to increased morbidity, mortality, length of hospital stay and healthcare expenditures.2 Rational use of drugs is based on ‘Rule of Right’ - ‘The right drug given to the right patient at the right time with the right doses’. They should also fulfill safety, affordability, need and efficacy.3 Prevention of antibiotic misuse is the key for controlling the antibiotic resistance. Approximately, 80 % of antibiotic are used in primary care in India.4 Therefore, it is immensely important to review in and outpatient prescribing practice on regular intervals. We therefore, initiated this study to investigate the present status of inpatient prescription pattern of antibiotics in urban and rural healthcare facilities in Bangladesh. Materials and Methods Total 2058 admitted patient were included in this study. All relevant information were collected by trained data collectors from the patient’s treatment record file and documented in a pre-designed data sheet. These include the features of infection, culture and related investigations, diagnosis, antibiotics given with dose, route, and duration of therapy. Ethical approval was obtained from Institutional review committee of Ibrahim Medical College. Informed consent was obtained from all participants and facilities involved in the study. Result     Table-2: Indication and pattern on antibiotic prescription at TLHs & PLHCs   Discussion According to World Health Organization (WHO), 15% to 20% prescriptions are expected with antibiotics in most of the developing countries where infectious diseases are more prevalent.6 In the present study, we have found that more than 85% of admitted patients were treated with antibiotics in TLHs. The rate was high as 100% in PLHCs. Similar trend of frequent antibiotic use had been reported from Pakistan (78%), Nepal (79.9%) and India (80%).7-9 Most common suspected infection was respiratory tract infection followed by gastro-intestinal tract infection. In acute gastro-intestinal and respiratory tract infections antibiotic are often not needed as viruses are the most common cause. WHO guideline for the treatment of diarrhea, clearly mention that antibiotics should not be used routinely. It is not possible to distinguish clinically the episode of diarrhea caused by enterotoxigenic E. coli from those caused by rota viruses.10 This type of practice may be due to over estimation of severity of illness, demand of rapid symptomatic relief by patients and tendency towards empirical therapy rather than personalized therapy. It was also observed that ceftriaxone was the most frequently (39.64% in TLH, 59.64% in PLH) prescribed antibiotics in admission followed by ciprofloxacin (19.23% in TLH & 15.69% in PLH). The extensive use of third generation parentral cephalosporins has caused the emergence of extended spectrum beta-lactamases in Gram-negative bacteria worldwide.11,12 Third generation cephalosporins are being widely used in hospitals as empirical and prophylactic therapy. This would eventually limit their usefulness in life threatening conditions. Moreover, it appears that there was a tendency to use injectable antibiotics over oral forms. A large proportion of patients were given multiple antibiotics. Such irrational multidrug prescription would lead to increased cost of therapy, more adverse reaction and emergence of resistance.   1.    Ehijie FO Enato and Ifeanyi E Chima. Evaluation of drug utilization patterns and patient care practices. West African Journal of Pharmacy 2011; 22(1): 36–41. 3.    Islam MR, Misbahuddin M. General Principles of Pharmacology. 5th ed. Dhaka: Bengal Library2006; 170-73. 5.    Minyahil A, Woldu, Sultan Suleman, Netsanet Workneh and Hafty barhane. Retrospective study of the pattern of Antibiotic Use in hawassa University Referral Hospital Pediartric ward, Southern Ethiopia. Journal of Applied Pharmaceutical Science 2013; 3(02): 93-98. 7.    Das N, Khan AN, Badini ZA, Baloch H. Prescribing practices of consultants at Karachi, Pakistan. J Pak Med Assoc 2001; 51: 74-77. 9.    Kumari Indira KS, SJ Chandy, L Jeyaseelan, Rashmi Kumar, Saradha Suresh. Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India. Indian J Med Resm 2008; 128: 165-171. 11.  Cosgrove SE, Kaye KS, Eliopoulous GM, Carmeli Y. Emergence of third-generation cephalosporin resistance in Enterobacter species. Arch Intern Med 2002; 162: 186-190. 2026 Ibrahim Medical College. All rights reserved.