Details
Category: Volume 06 Issue 01 January 2018
Hits: 1392

Title: An Analysis of the Pharmacological Management of Respiratory Tract Infections in-Patients at a Tertiary Care Teaching Hospital

Authors: Dr Paramita Pal, Dr Dipankar Bhattacharyya, Dr Kokila BN, Dr Herle M, Dr Anoljyoti Ghosh, Dr Biplab Kr Mitra

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.16

Abstract

Background: Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx—to life-threatening illnesses such as epiglottitis. Antimicrobials are the mainstay in the management and irrational use of them may increase resistance to bacteria and the total cost of treatment.

Objectives: To evaluate the pattern of drug prescriptions for respiratory tract infections in Medicine and Pediatric outpatient departments of a rural teaching hospital.

Methods & Patients: Over a period of 18 months, 391 prescriptions of outpatients with respiratory tract infection were collected. The drugs prescribed, their dose and duration of treatment were recorded.  DU 90% was calculated.

Results: Data from a total of 603 medical case records pertaining to respiratory tract infective disorders were assessed. The mean (±SEM) age of the patients was38.55±0.9 years and there were 204 (52.1%) men and 187 (42.1%) women. The most common disorder among the patients was acute rhinitis (61.1%) while the least common was acute bronchitis (1.3%). The prevalence of RTIs was slightly higher in males. The preferential AMAs employed were amoxicillin, amoxicillin-clavulinic acid combination, ceftriaxone, cefixime and azithromycin used individually. Of 12 different AMAs prescribed in this study, 6 drugs (penicillin, cephalosporin, aminoglycosodes, ATT, macrolides and fluroquinolones) falls within DU90% segment. Bronchodilators and expectorants, mucolytics, cough suppressant, decongestants combination is noteworthy. The concurrent use of different groups of bronchodilators along with inhalational corticosteroids is also highlighted. Ranitidine, omeprazole and pantoprazole were the foremost gastroprotective agents. A variety of heterogenous adjuvants other than those mentioned above were administered and their roles in conferring additional therapeutic benefits have been emphasized. Majority of drugs used are from NLEM 2011.

Conclusion: Penicillins and cephalosporins were the commonly used antibiotics for respiratory tract infection in outpatients of a rural teaching hospital and two thirds of the prescribed drugs were essential medicines. The overall impression about the prescription trends noted herein is suggestive of modest and rational approach in prescribing practices.

Keywords: Respiratory tract infections, Drug utilization, Antimicrobial agents.

References

  1. Ashworth M, Charlton J, Ballard K, et al. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995–2000. British Journal of General Practice. 2005; 55:603–8.
  2. Lindbaek M. Prescribing antibiotics to patients with acute cough and otitis media. British Journal of General Practice. 2006; 56:164–5.
  3. Finch RG. Epidemiological features and chemotherapy of community-acquired respiratory tract infections. Journal of antimicrobial chemotherapy 1990; 26:53.
  4. Nandimath MK, Ahuja S. Drug prescribing pattern in upper respiratory tract infection in children aged 1–14 years. International Journal of Pharma and Bio Sciences 2012; 3(1):299-308.
  5. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379:2151-61.
  6. Mulholland K. Childhood pneumonia mortality: a permanent global emergency. Lancet. 2007; 370:285-9.
  7. Campbell H. Acute respiratory infection: a global challenge. Arch Dis Child. 1995; 73:281.
  8. Victora CG, Fenn B, Bryce J, Kirkwood BR. Cocoverage of preventive interventions and implications for child-survival strategies: evidence from national surveys. Lancet. 2005; 366:1460-6.
  9. Jawade PG, Sukhsohale ND, Jawade GG, Khan BZA, Kakani PK, Aklujkar SP, et al. Clinico-epidemiological profile of acute respiratory infections and malnutrition in urban and rural population of central India. Int J Contemp Pediatr 2017; 4:159-66.
  10. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States.JAMA 1995; 273:214-9.
  11. Gaash B. Irrational Use of Antibiotics. Indian Journal for the Practicing Doctor 2008; 5(1):03-04.
  12. Laporte JR, Porta M, Capella D. Drug utilization studies: A tool for determining the effectiveness of drug use. J. Clin. Pharmacol. 1983; 16:301-4.
  13. Naik HG, Khanwelkar CC, Kolur A, Desai A, Gidamudi S. Drug Utilization Study on Antibiotics use in Lower Respiratory Tract Infection. National Journal of Medical Research 2013; 3(4):324-27.
  14. Truter I. A Review of Drug Utilization Studies and Methodologies. Jordan Journal of Pharmaceutical Sciences 2010:1(2):6.
  15. How to investigate drug use in health facilities: Selected drug used indicator. World Health Organization 1993; 93(1):28-31.
  16. Zhanel GG, Karlowsky JA, Low DE, Hoban DJ. Antibiotic resistance in respiratory tract isolates of Haemophilus influenzae and Moraxella catarrhalis collected from across Canada in 1997-1998. J Antimicrob Chemother 2000; 45:655-62.
  17. Prajapati V, Bhatt JD. Study of prescribing patterns of antimicrobial agents in the paediatric wards at tertiary teaching care hospital, Gujarat. IJPSR 2012; 3(7):2348-2355.
  18. Mossad SB. Upper Respiratory Tract Infections. Cleveland: The Cleveland Clinic Foundation; August 2013. [Available in http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/upper-respiratory-tract-infection/, cited 2014-09-24]
  19. Gonzales R, Bartlett JG, Besser RE, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults. Ann Intern Med 2001; 134:490-4.
  20. Cheong YM, Fairuz A, Jegathesan M. Antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley. Singapore Med J 1995; 36:43-6.
  21. Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: A national survey 1989-1999. JAMA 2001; 286:1181–6.
  22. Hong CY, Lin RTP, Tan ESL, Chong PN, Tan YSL, Lew YJ, Loo LH. Acute respiratory symptoms in adults in general practice. Fam Pract 2004; 21:317-23.
  23. Amin R, Hoque AMW, Khan RF, Rahman M. Considering respiratory tract infections and antimicrobial sensitivity: An exploratory analysis. Malaysian Journal of Microbiology 2009; 5(2):109-112
  24. Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatrics 2001; 68:1135-8.
  25. Finegold SM, Johnson CC. Lower respiratory tract infection. The American Journal of Medicine 1985; 79(5):73-7.
  26. Naik HG, Khanwelkar CC, Kolur A, Desai R, Gidamudi S. Drug utilization study on antibiotics use in lower respiratory tract infection. National Journal of Medical Research 2013; 3(4): 324-327.
  27. Mandell LA, Bartlett JG, Dowell SF, et al. Update of practice guidelines for management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003; 37:1405-1433.
  28. Chesnutt MS, Prendergast TJ, Tavan ET. Pulmonary disorders. In, McPhee SJ, Papadakis MA, (editors). Current Medical Diagnosis & Treatment. 51st United States of America: McGraw Hill Medical publication; 2012.p.271, 280-287
  29. Naik HG, Khanwelkar CC, Kolur A, Desai A, Gidamudi S. Drug Utilization Study on Antibiotics use in Upper Respiratory Tract Infection. International Journal of Recent Trends in Science and Technology 2014; 10(2):299-302
  30. Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, et al. Guidelines for Diagnosis and Management of Community and Hospital Acquired Pneumonia in Adults: Joint ICS/ NCCP (I) Recommendations: The Indian Journal of Chest Diseases & Allied Sciences 2012; 54: 267-281 / Lung India 2012; 29: S27-S62.
  31. Tripathi KD. Drugs for cough and bronchial asthma. In: Essentials of Medical Pharmacology. 7th New Delhi: Jaypee Brothers; 2013.p.218-233.
  32. Snijders D, Daniels JM, DeGraaff CS, vanderwerf TS, Boersma WG. Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blinded clinical trial. Am J Respir Crit Care Med 2010; 181(9):975–982.
  33. Patil L, Khairnar A. Ninety percent drug utilization in patients of upper respiratory infections: Int. Res. J. Pharm 2013; 4(6): 189-193
  34. Iyer GS, Patel PP, Panchal1 JR, Dikshit RK. An analysis of the pharmacological management of respiratory tract infections in pediatric in-patients at a tertiary care teaching hospital. International Journal of Medicine and Public Health 2013; 3(3):140-145.

Corresponding Author

Dr Dipankar Bhattacharyya

Associate Professor, Department of Physiology,

Jagannath Gupta Institute of Medical Sciences And Hospital,

Budge Budge, West Bengal 700137, India