Antibiotic prescribing in outpatients: hospital and seasonal variations in Ujjain, Madhya Pradesh, India

Abstract number: O476

Pathak A., Mahadik K., Dhaneria S., Marrone G., Lundborg C.

Objective: To explore seasonal patterns of antibiotic prescribing for selected infectious disease complaints for children up-to 5 years and adults (>18 years) reporting to out patient clinics of two hospitals in Ujjain.

Methods: This was cross sectional study; during 15 months period from 15th November 2007 to 15th February 2009. It covered 4 seasons, 2 winters, one summer and one rainy season. First consultations of all patients for suspected infectious aetiology at outpatients of two hospitals (one for profit and other academic) were included. A diagnosis prescribing form was filled by the treating consultant for each patient irrespective of whether an antibiotic was prescribed or not. An average of 70% of available consultants participated. Each prescribed antibiotic was coded according to the WHO Collaborating Centre for Drug Statistics Methodology, ATC classification index with DDDs 2009. All DDDs were calculated/1000 patients/diagnosis (DDD/TPD). Stata 10.0 was used for appropriate statistical tests.

Results: Out of a total of 5,733 patients antibiotics were prescribed in 3,732 (66.3%). These prescriptions contained 1–3 antibiotics, with a mean of 1.28 antibiotics per prescription. Indications were respiratory tract infections (32.2%), vaginal discharge (26.3%), urinary tract infections (16.3%), skin and soft tissue infections (15%), diarrhoea (9.2%) and prophylaxis (1%). Quinolones were the commonest group prescribed. Antibiotic prescribing was 37% less in academic hospital (P < 0.001). Prescribing peaked in rainy season with 70% of patients prescribed antibiotics. The independent predictors of antibiotic prescribing were seasons (2nd winter > 1st winter), facility (for profit > academic), age groups (adults > children), education level (illiterate > more educated), productive cough at presentation, ear discharge, pneumonia and dysentery. The number of patients per diagnosis, prescription rate with commonest prescribed antibiotic group with DDDs/ TPD per group is shown in table.

Conclusions: Statistically significant association between antibiotic prescribing and seasons, for profit hospital, age groups, education level, symptom of productive cough at presentation, ear discharge, pneumonia and dysentery was found. High use of quinolones is a cause of concern.

Table. Number of patients per diagnosis, prescription rate with commonest prescribed antibiotic groups with Defined Daily Doses/1000 patients/diagnosis (DDD/TPD) per group

DiagnosisNumber of patientsOverall prescription rate %Name and DDDs/TPD of commonest antibiotic group/antibiotic
URTI72838.6Quinolones 435.8
Levofloxacin 264
Ear discharge10596.2Co-amoxiclav 152.7
Pneumonia42289.4Quinolones 1889
Levofloxacin 1597.8
Vaginal discharge136172.2Metronidazole 11632.5
Doxycycline 9183
Quinolones 434.2
UTI64796.1Quinolones 3647.2
Metronidazole 2893
Diarrhoea52553Imidazole group 713
Co-trimoxazole 587.6 DUs/TPD
Dysentery6997.1Quinolones 2118.6
Imidazole group 863
SSTI*57592.4Co-trimoxazole 4032.5 DUs/TPD
Quinolones 1873.4
URTI: Upper respiratory tract infection; UTI: Urinary tract infection; *SSTI: Skin and soft tissue infections.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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