Mali Nitin Bhagwan, Deshpande Siddharth P, Karnik Niteen D, Gogtay Nithya J, Munshi Renuka P, Divatia Jigeeshu V, Wagle Sanjay C, Sridharan Kannan, Thatte Urmila Mukund
Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Clinical Pharmacology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
Indian J Crit Care Med. 2018 Oct;22(10):723-729. doi: 10.4103/ijccm.IJCCM_197_18.
Antibacterials are largely prescribed to the intensive care unit (ICU) patients due to high prevalence of infections. However, appropriate use of antibacterials is imperative; since the misuse of antibacterials increases antibacterial resistance and ultimately, it has negative impact on health care and economic system. Hence, continuous antibacterials prescription assessments are very important to judge and improve prescription patterns. The present work was carried out at public and private hospitals to assess the differences in antibacterial prescribing pattern.
The present study was conducted at three public and two private hospitals over the period of 14 months. Demographic and drug use details were captured daily from patients admitted to medical ICUs to assess the World Health Organization indicators.
A total of 700 patients were enrolled across the five centers (140 per center), among them 424 were male and 276 were female. Average number of drugs and antibacterials prescribed at public hospitals are significantly higher than the private hospital. However, percentage of antibacterial agents prescribed at public hospitals was significantly lower than the private hospitals ( = 0.0381). Private hospitals had significantly lower percentage of antibacterial agents prescribed by generic name ( < 0.0001). Differences in change of antibacterial agents required were not statistically significantly different ( = 0.1888); however, significant difference was observed in percentage of patients who received antibacterial treatment as per sensitivity pattern ( = 0.0385) between public and private hospitals. Significantly higher mortality was observed in public hospitals compared to private hospitals (<0.0001).
More generic prescriptions and more number of prescriptions as per the sensitivity pattern are required at each public and private hospital.
由于感染的高发生率，抗菌药物在重症监护病房（ICU）患者中大量使用。然而，必须合理使用抗菌药物；因为抗菌药物的滥用会增加抗菌药物耐药性，最终对医疗保健和经济系统产生负面影响。因此，持续进行抗菌药物处方评估对于判断和改善处方模式非常重要。本研究在公立医院和私立医院开展，以评估抗菌药物处方模式的差异。
本研究在3家公立医院和2家私立医院进行，为期14个月。每天收集入住内科ICU患者的人口统计学和用药细节，以评估世界卫生组织的指标。
五个中心共纳入700例患者（每个中心140例），其中男性424例，女性276例。公立医院开具的平均药物数量和抗菌药物数量显著高于私立医院。然而，公立医院开具抗菌药物的比例显著低于私立医院（P = 0.0381）。私立医院按通用名开具抗菌药物的比例显著较低（P < 0.0001）。抗菌药物更换需求的差异无统计学意义（P = 0.1888）；然而，公立医院和私立医院之间按照药敏模式接受抗菌治疗的患者比例存在显著差异（P = 0.0385）。与私立医院相比，公立医院的死亡率显著更高（P < 0.0001）。
每家公立医院和私立医院都需要增加通用名处方，并按照药敏模式增加处方数量。
