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Abstract
Objectives To present and compare antibiotic prescribing for inpatients among the most common non-bacterial diagnoses groups at medicine departments of a teaching (TH) and a non-teaching hospital (NTH) in central India.
Setting An observational cross-sectional study was conducted at two tertiary care settings in Ujjain district, Madhya Pradesh, India.
Data and participants The data were collected manually, using a customised form. Complete records of all inpatients, who were >15 years of age and had stayed for at least one night in either of the hospitals during 2008–2011, were analysed.
Outcome measures Inpatients were grouped according to the presence or absence of a bacterial infectious diagnosis, viral/malaria fever or cardiovascular disease. Classes of antibiotics prescribed to these groups and adherence to the available prescribing guidelines were compared between the hospitals using the notes from the patient files and the diagnoses.
Results Of 20 303 inpatients included in the study, 66% were prescribed antibiotics. Trade name prescribing and use of broad-spectrum antibiotics were more frequent at the NTH than at the TH (p<0.001). At the TH a significantly higher proportion of patients having fever without registered bacterial infection were prescribed antibiotics (82%) compared with the NTH (71%, p<0.001). Patients admitted for cardiovascular diagnosis without registered bacterial infections received antibiotic prescriptions at both hospitals (NTH 47% and TH 37%) but this was significantly higher at the NTH (p<0.001). None of the diagnoses were confirmed by microbiology reports.
Conclusions Prescribing antibiotics, including broad-spectrum antibiotics, to inpatients without bacterial infections—that is, viral fever, malaria and cardiovascular disease, was common at both hospitals, which increases the risk for development of bacterial resistance, a global public health threat. In view of the overprescribing of antibiotics, the main recommendations are development and implementation of local prescription guidelines, encouragement to use laboratory facilities and prescription analysis, with antibiotic stewardship programmes.
- Private sector hospitals
- Medicine department
- Antibiotics
- Non-bacterial infections
- Inpatients
- India
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Footnotes
CSL and MS share last authorship.
Contributors MS and CSL designed, visualised the research question and developed the data collection tool. MS conducted repeated training sessions for nursing personal for recording the data; was responsible for coordination with the nursing staff, monitoring and supervision of the data collection and entry. CSL participated in planning the study design and coordination of the study. KL, CSL and MS participated in the conception and design of the study and revising the paper critically for substantial intellectual content. KL grouped and analysed the data, performed the statistical analysis and contributed to drafting of the manuscript together with MS, CSL, FJ and AS. KL, AS and MS were responsible for categorisation of the patients. All authors read and approved the final version of the manuscript.
Funding This study was supported by the Swedish Research Council (K2007-70X-20514-01-3 and K2013-70X-20514-07-5) and Asia Link (348 -2006 -6633). KL and FJ both received scholarships from Sida to visit the study settings. MS is a recipient of a scholarship from Erasmus Mundus External Cooperation Window Lot-15, India.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement In accordance with institutional policy, the data are available at the institutional ethics committee. This is to protect the patient's confidentiality and to ensure the electronic security of the data. The data can be made available to all interested researchers on request from The Chairman, Ethics Committee, R.D. Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India 456006 (email: iecrdgmc@yahoo.in, uctharc@sancharnet.in), giving all details of the article. The ethical approval number: 41/2007 needs to be quoted with the request.