title: Investigation of antimicrobial use pattern in the intensive treatment unit of a teaching hospital in western Nepal.
abstract: BACKGROUND
  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
  A total of 297 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. Patient outcome, duration of stay in the intensive treatment unit, and the age and sex distribution of the patients were also studied.
  
  
  RESULTS
  Mean+/-SD drugs per patient was 3.4+/-1.8. About half (50.2%) of the patients received an antimicrobial; 84.6% of the antimicrobials were used without obtaining bacteriologic evidence of infection. The commonest organisms isolated on culture were Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pneumoniae, and Staphylococcus aureus. A total of 28.9% of the antimicrobials were prescribed for lower respiratory tract infections on the basis of the putative site of infection; 61.9% of the antimicrobials were prescribed by the parenteral route and mainly the older generation of antimicrobials were used. In 39 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 inappropriate use and unnecessary cost to the patients are required. The high percentage of inappropriate use of antimicrobials raises concerns about the development and spread of drug resistance, which must be addressed.
authors.affiliation: Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal.
authors.forename: P Ravi
authors.initials: PR
authors.lastname: Shankar
authors.forename: Praveen
authors.initials: P
authors.lastname: Partha
authors.forename: Nagesh
authors.initials: N
authors.lastname: Shenoy
authors.forename: K N
authors.initials: KN
authors.lastname: Brahmadathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D017723:Drug Utilization Review; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents