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clinmed/2002050008v1 (July 26, 2002)
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Investigation of antimicrobial use pattern in the intensive treatment unit of a teaching hospital in western Nepal
Ravi P Shankar, Praveen Partha, Nagesh K Shenoy, and Kailash N Brahmadathan
Introduction: Inappropriate use of antimicrobials is of special importance in the intensive treatment unit because of the large number of drugs prescribed, the chance for drug errors and the likelihood of development of drug resistance. Methods: 297 inpatient records of patients admitted to the intensive treatment unit of the Manipal teaching hospital, a tertiary care hospital in Pokhara, western Nepal were studied to determine the prescribing frequency and rationality of use of antimicrobials. The patient outcome, the duration of stay in the intensive care unit and the age and sex distribution of the patients were also studied. Results: Mean ± SD drugs per patient was 3.45 ± 1.78. 50.17% of the patients received an antimicrobial. 84.56% of the antimicrobials were used without obtaining bacteriological evidence of infection. The commonest organisms isolated on culture were Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus. 28.86% of the antimicrobials were prescribed for lower respiratory tract infections based on the putative site of infection. 61.86% of the antimicrobials were prescribed by the parenteral route and mainly the older generation of antimicrobials were used. In 39 out of the 149 patients prescribed an antimicrobial the use was irrational. Conclusions: Prescriber education to improve prescribing patterns and regular auditing of antimicrobial prescriptions to prevent their irrational use as well as unnecessary cost to the patients are required. The high percentage of irrational use of antimicrobials raises concerns about the development and spread of drug resistance and this has to be addressed.