Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India.
OBJECTIVE
High utilization and inappropriate usage of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU) increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU.


METHODS
A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification) as well as individual drugs and their costs were recorded.


RESULTS
One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77%) was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%), metronidazole (12%), amoxicillin/clavulanic acid (6.44%), and azithromycin (4.34%). Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR).


CONCLUSIONS
A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
Nikhilesh
N
Anand
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
I M
IM
Nagendra Nayak
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
M V
MV
Advaitha
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
Noble J
NJ
Thaikattil
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
Kiran A
KA
Kantanavar
Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India.
Sanjit
S
Anand
Antimicrobial agents; DDD/ATC; Intensive Care Unit; cost analysis; drug utilization study