Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital

Abstract

Background: Patients admitted to the Intensive care unit receive multiple medications from a variety of pharmacological classes due to various life threatening illnesses. This study was conducted to assess the patterns of antimicrobial agents and to suggest necessary modifications in prescribing practices to achieve rational therapeutic practices. The present study aims to study the prescribing patterns of drugs and rationality of antimicrobial drug use in the medical ICU of a tertiary care hospital. Methods: A prospective observational study was carried out at the 15 bedded medical ICU of St. John's Medical College Hospital, Bangalore from October 15th 2006 to September 15th 2007. The relevant data on drug prescription of each patient was collected from the inpatient case record. Drugs were classified into different groups based on WHO-ATC classification. The demographic data, disease data and the utilization of different classes of antimicrobial agents as well as individual drugs were analyzed. Results: Of the 902 patients admitted in the medical ICU during the study period, 728(81%) consecutive patients were included for the analysis. Male to female ratio was 1.9. The mean for age was 49.21±15.84 years. Extensive polypharmacy (100%) was noticed. The average number of drugs per patient (prescription) was 11.6± 2.09. Cephalosporins 505 (69.3%) and aminoglycosides 263(35%) were the commonly prescribed antimicrobial drug class. Cefoperazone (J01DD12) 218 (30%), amikacin 211(28.9%), metronidazole 208(28.6%) were the commonly prescribed antimicrobial drug class. A total of 228 perscriptions (31.3%) contained two antimicrobial prescription and (187) 25.7% contained 3 drugs. Cefoperazone + sulbactam (J01DD62) 224(30.8%) was the most common FDC noticed. Conclusion: A wide spectrum of clinical disorders was noticed. Overall extensive poly-pharmacy and poly-pharmacy among antimicrobial agents was noticed.