Rational use of antibiotics at primary and secondary healthcare facilities in district Panchkula, Haryana, North India: A cross-sectional study

Abstract

Background & objectives: Antimicrobial prescriptions by doctors are crucial in managing acute illnesses but contribute significantly to antimicrobial resistance if misused. This study aimed to assess the rational use of antibiotics in outpatient public healthcare settings in Panchkula, Haryana. Methods: A cross-sectional study was conducted across 18 primary and two secondary healthcare facilities in the district of Panchkula, Haryana. Antimicrobial prescriptions (n=945) were assessed for comprehensiveness and rationality using the pretested and validated antimicrobial prescription assessment tool and standard treatment guidelines. World Health Organisation’s anatomic therapeutic chemical and defined daily dose index (WHOCC-ATC/DDD) was used to calculate defined daily dose (DDD) for adult prescriptions, and days of therapy (DOT) were calculated for paediatric patients. We used descriptive statistics to summarise the findings and chi-square test to compare the proportions of rational and irrational prescriptions. Results: Of 945 antibiotic prescriptions, only 0.4 per cent (n=4) of prescriptions were comprehensive. Among prescriptions eligible for rationality assessment (n=647, 68.5%) antibiotic therapy was indicated in 44 per cent (n=285), of which only 3.5 per cent (n=33) were rational, 20.2 per cent (n=191) moderately rational and 76.3 per cent irrational (n=721). Irrational prescriptions were most common in respiratory (n=415, 95%), gastrointestinal (n=105, 92.9%), and dermatological (n=21, 76%) ailments. The completeness of the prescriptions was low, with information on dosage of antibiotics (n=265, 28%), laboratory investigations (n=331, 35%), diagnosis (n=94, 10%), and co-morbidities (n=96, 10%). The prescribed antibiotic doses exceeded the WHO-DDD recommendations, with irrational prescribing significantly higher among paediatric prescriptions (89.6%) as compared with adult prescriptions (74.3%; adjusted odds ratio 1.36, 95% confidence interval 1.1-1.7, P<0.001). Interpretation & conclusions: Antibiotic prescriptions in primary and secondary care outpatient departments demonstrated widespread irrationality, highlighting the importance of implementing a comprehensive antimicrobial stewardship programme in these settings.