Profile of Antibiotic Use at the Health Centre of Delta State University Abraka
CHAPTER ONE
Specific objective
- To determine the proportion of students treated with antibiotics and other drugs.
- Evaluating the total number of antibiotics prescribed and their order of distribution.
- Determining the factors related to the antibiotics prescription pattern.
- To determined the single antibiotic drug that was prescribed during this study.
- To determined the combined antibiotic drug that was prescribed during this study
CHAPTER TWO
LITERATURE REVIEW
This review of literature explored the main concern centred on antibiotic prescribing patterns among physicians in the hospital setting.
A study which was done in Jammu city, India by Sharma and Kapoor, (2003), aimed at assessing the prescribing pattern for evaluation of rational drug therapy. The study involved reviewing 200 prescriptions that were written by qualified medical graduate and post graduate doctors. The study showed that there was inappropriate prescribing in 33 percent of the drugs and that a large number of prescriptions did not conform to the ideal pattern (Sharma and Kapoor, 2003).Their study was retrospective and did not only include physicians but interviewed patients as well. However, this study did not involve interviewing of patients as they would have not known why certain antibiotics were prescribed for them but merely reviewed their prescriptions.
Gyssens et al., (2011) looked at antibiotic stewardship programmes and evidence-based principles of prudent antibiotic prescribing. They concluded that by applying strategies for appropriate prescribing optimise indication, selection, dosing, route of administration, duration, and timing of antibiotic therapy, selection of resistant microorganisms could be reduced to the minimum. Bijnen et al., (2011), defined appropriateness as the congruency between resistance patterns and prescription patterns. This study did not look at the resistance patterns. Therefore, Bijnen and colleagues’ definition was not applicable to this study.
Acimis et al., (2009) undertook a cross sectional survey titled ‘The Prevalence of Prescribing Antibiotics by Primary Health Care Physicians in Turkey: A multi-centered Survey’ in which 267 physicians participated. The study reported that 22.6% of the reviewed prescriptions had antibiotics. The most prescribed antibiotics were amoxicillin+ clavulanic acid (15.6%) and amoxicillin + sulbactam (15.1%). Of the conditions recorded, acute upper respiratory infections accounted for 53.3% and Urinary Tract Infections accounted for 16.4% (Acimis et al., 2009). Their methodology also included factors that affected prescribing patterns of physician. A similar study on prescribing patterns conducted at the Hospital of Kathmandu Valley in East Africa, evaluated the prescribing practice of antibiotics in hospital in-patients. The study showed that more than 98% of patients were exposed to at least 2 antibiotics and of those only 24 cases had specimens taken for culture (Palikhe, 2004).
In South Africa, a study conducted in Vhembe district, Limpopo province by Makhado (2009) compared antimicrobial prescribing patterns with Standard Treatment Guidelines and Essential Drug List in primary Healthcare facilities. It was noted that the highest rate (28%) of antibiotics prescribed was in children of the age group from birth to 10 years followed by 11 to 20 years (24.2%). The number of items per prescription was found to be 2.6 and the average number of antibiotic per prescription out of the 500 prescriptions that had antibiotics was 1.17. Only 26.77% of the prescribed antibiotics were by generic names. The duration of treatment was indicated in 12.67% of prescriptions and 71.27% of the prescriptions had the frequency recorded. The study further found that indications were either recorded as symptoms or diagnosis. However, the majority of indications which were recorded did not appear in the Standard Treatment Guidelines as diagnosis (Makhado, 2009).
CHAPTER THREE
RESEARCH METHODOLOGY
Methodology
This chapter deals with the study design, study setting, data source and target population, method of data analysis, data collected, data analyze and ethical consideration/approval.
Study Design
A retrospective study was conducted from January to June 2015,a total number of 592 patients was obtained in pharmacy department at the health centre of Delta State University, Abraka.
Study Setting
This study was carried out at the health centre of Delta State University, Abraka. At site II, the health centre consist of six departments which include the administrative section, doctors sections, pharmacy section, Nursing section, Laboratory section and the Medical record section.
The administrative section is the intermediate between the health service department and the central administrative department of the university. This section has staffs whose responsibilities are both internal and external administrating work. This section also has the national health insurance scheme (NHIS) that registers staffs and their dependants. The doctors section comprises about 16 doctors who work at different time frame attending to students, staffs of the institution and other patients. This section is headed by the medical director who also oversees the administrative and other sections of the heath centre.
The pharmacy section has 2 units which is headed by the assistant director. On unit attends to students while the other to staff and their dependents below 18years of age and to people who registers under the NHIS scheme. They also supply little quantity of drugs and injections to the nursing section for emergency cases.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS OF RESULT
Introduction
This chapter describes the simple characteristics which include important demographic detail of surveyed patients, single antibiotic prescribed, combined antibiotics prescribed, classes of antibiotics prescribed, most prevalent conditions treated with Antibiotics, route of drugs administration .It also provides detail on the state of antibiotic usage in terms of appropriateness and the availability of a copy of World Health Organisation (WHO) model list of essential medicines. Additionally, key drugs in stock from the essential drug list, factors that influence prescription, control measures that regulates antibiotic use and compliance of pharmacy toward Gyssen’s el at, recommendation and core use indication was analyzed.
Age Distribution of Patient Base on department
A total of 592 records of patients were obtained from the pharmacy department. Among them, 110(18.58%) of the patient belong to the age category of 15-20 years, 201(33.95%) belong to 21-25 years, 99(16.72%) belong to 26-30 years, 86(14.53%) belong to 31-35 years and 96(16.22%) belong to > 36years.
CHEAPER FIVE
DISCUSSION, CONCLUSION, SUMMARY AND RECOMMENDATIONS
Discussion
In the study, it was found that the profile of antibiotics used at the Health Centre of Delta State University, Abraka was rightly prescribed. The evidence was that the antibiotics used were prescribed for therapy because 21/25 condition treated were bacterial infections confirmed by laboratory test.
The drugs of choice, duration of therapy, route of administration were mostly appropriate.
This study also found that the doctors usually refer to the following treatment guideline for prescription, Standard best practice British National formulary Monthly index of medicines specialities
The study also revealed that national drug prescribing did not conform to set standards. Poly-pharmacy was quite common and this may lead to a high chance of drug interaction, toxic adverse effects and high cost of treatment. The evidence is the average number of drug per encounter which was found to be 2.78.
In the study, 19-22 years age group were higher with a frequency of 201(33.95%), followed by 15-18 years with a frequency of 110(18.58%), 20–26 years with a frequency 99(16.72%), 27-30 years with a frequency 96 (16.22%) and the least among them were >31 years with a frequency of 86(14.53%).
Among the study patients in pharmacy department, the female were higher with a frequency of 316(53.38%) than the male with a frequency of 276(46.62%).
Three route of drug administration were utilized. These are oral, intravenous and intramuscular. Oral route were mostly used for both male and female, followed by intravenous and intramuscular.
The study found that the most prescribed single antibiotic were flagyl, amoxyl, ampiclox, azithromycin, doxycycline and septrin. It was found that flagyl had a frequency of 281(33.53%) amoxyl 108(12.89%), azithromycin 99(11.81%), ampiclox 92(10.98%) and septrin 42(5.01%) and the least among them were ciprofloxacicin 4(0.48%) and chloramphinicol 6(0.72%).
In the study, the most combination antibiotic use were azithromycin / flagyl, amoxyl / flagyl, doxycycline / flagyl, ciprofloxacin, doxycycline / flagyl / azithromycin and septrin / flagyl, azithromycin / ampiclox. It was found that azithromycin/flagyl had a frequency of 46(23.35%), amoxyl/flagyl 38(19.29%), doxycycline / flagyl 33(16.75%) ciprofloxacin / doxycycline/ flagyl / azithromycin 9(4.54%) septrin / flagyl 8(4.06% and azithromycin / ampiclox 11(5.58%).
The beneficial effects of combination therapy was predominantly seen with b-lactams as primary therapy including, macrolides, quinolones and aminglycoside. The benefit of combination therapy was significantly for bacteremic and non-bacteremic infections.
The study also shows that penicillin group topped the table of most used class of antibiotic and this is in agreement with the finding of Chelliah et al., 2005). Other antibiotics were ranked second and followed by macrolide and tetracycline. In this study, similar to finding of Khan et al., 2012), penicillin and macrolide have continued to be the mainstay of therapy in Delta Health Centre because of their wider spectrum of activity. Clinical efficacy and favourable compliance/tolerability profile (Borg et al., 2008, Mettler et al., 2007, Singh et al., 2001).
In this study, it was found that a good number (93.92%) of the 592 patient evaluated had antibiotic prescribed.
In this study, it was observed that antibiotic was mostly used for bacteria infections, with very little for non-bacterial infection. Plasmodiasis topped the table of conditions treated. 63(10.29%), followed by stooling 51(8.33), anaemia 48(7.84%), heat rashes 45(7.35), cough and fever 42(6.84%), gastroenteritis and urinary tract infection 39(6.37%), asthma 33(4.39%) and respiratory tract infection 31(5.06%) respectively. The five (5) least condition treated were gunshot injury/wound 4(065%), appendicitis 6(0.98%) meningitis and bruised/laceration at 8(1.31%) at each and peptic ulcer disease at 11(1.80%). This was contrary to the findings of Gopal et al., (2014) that antibiotic used in their study was mostly for non bacterial infection.
Conclusion
Despite the appropriate use of antibiotics in the health centre, the main challenge remains to achieve a rational drug choice. It can be concluded therefore, that poor adherence and compliance of prescribers towards adopted standard treatment guideline such as the core drug use indicator (CDUI) is the major reason for this. To achieve the goal of rational use of medicine and improve prescribing patterns, it is pertinent to reduce the number of medicine as low as possible after consciously keeping the cost of therapy low.
Limitation to the study
The following limitations to the study were identified:
- Some condition treated could not be accurately assessed due to bad hand writing of prescribers.
- Sorting and filing of patients medical records was a challenge.
- Gyssen’s method was used as one of the standard for evaluation, it may however have its limitation depending on location and facilities.
- WHO core drug use indicator is not an exhaustive tool to identify all problems related to prescribing and rationality of drug use as they don’t explain exactly why drugs are prescribed.
Summary
This study evaluated the profile of antibiotic use at the health centre of Delta State University. A total of 592 patient prescriptions from pharmacy department, categories of patient were evaluated. A total of 838 antibiotic were prescribed standard used for evaluation.
Recommendation
Based on the study finding, the following recommendations are made:
- There is need for the hospitals to enforce adherence to standard treatment guideline to ensure rational drug prescribing.
- There is need to develop control measures to regulate antibiotics use.
- Clinical meetings should be held on a regular basis to evaluate drug use.
- Hospital managements should strengthen laboratory facilities so that prescriptions will remain on the basis of laboratory reports.
- Hospital management should ensure the availability of WHO model list of essential medicine and key drugs in the pharmacy store.
- Proper education programme on rational use of drug and antibiotic policies should be implemented in the hospitals.
- Motivating dispensary personnel to explain drug regimen thoroughly to patients as this implies patients knowledge of correct dose.
- Motivating generic prescribing (a safety precaution for the patient) as it gives clear identification and enables easy information exchange and allows better communication between health care provides.
- While this study identified poor adherence to CDUI as the main factor militating against rational drug prescribing, further studies should be conducted to prove the authenticity of this finding.
REFERENCES
- Acimis, N.M., Yazici, A.C., Gocmen, L. and Mas, R. (2009). The prevalence of prescribing antibiotics by primary health care physicians in Turkey: A multi-centred survey. Pak Journal of Medical Science, 25(5):706-711.
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