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TO ASSESS THE CRITERIA OF CHOICE OF ANTIMICROBIALS PRESCRIBED IN

VARIOUS CLINICAL DEPARTMENTS OF GOVT DOON HOSPITAL Rashmi Singla

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 ORIGINAL RESEARCH PAPER Volume - 11 | Issue - 08 | August - 2022 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

TO ASSESS THE CRITERIA OF CHOICE OF ANTIMICROBIALS PRESCRIBED IN

VARIOUS CLINICAL DEPARTMENTS OF GOVT DOON HOSPITAL

Pharmacology
Rashmi Singla Associate Professor, Pharmacology, Govt Doon Medical College
Rahul Bhatt MBBS Intern,GDMC.
Saurabh Bahuguna MBBS Intern, GDMC.
Minali Raja Associate Professor,Pathology ,GDMC
ABSTRACT
Background: The choice of antibiotic depends on antibiotic susceptibility of the causative organism. There are some infections which can be
treated by one or several drugs. The choice is based on most effective, least toxic with rapid action and good pharmacokinetics and with least cost,
for the precise duration of time to cure or prevent infection. Also, the diagnostic tests &culture sensitivity detect an infection and the causative
organism involved. Materials&Methods: The study was carried out in various clinical departments (Medicine, Surgery, Gynecs&Obstetrics,
Orthopedics, Pediatrics, ENT, ICU) in Govt Doon Hospital situated in Patel Nagar, Dehradun for a period of four months from January to April
2022. The data from 200 prescriptions was entered and tabulated regarding name of disease, treatment and dose , criteria of choice of
antimicrobials,in a departmentwise manner. Results: The criteria of choice as efcacy and availability were 100% & cost was important in case of
medicine dept. Safety was the criteria in case of antitubercular drugs and tolerability in case of pediatrics while giving metronidazole to children as
in gastroenteritis because of its adverse effects. Broad spectrum drugs are prescribed in empirical therapy and narrow spectrum after culture
sensitivity and diagnostic tests.A stepped up approach is used giving higher antibiotics in case of sepsis. Prophylactic therapy is given in cases of
communicable diseases and as surgical preoperative prophylaxis. Conclusion : The criteria of choices are important factors for laying guidelines
for antibiotic prescribing in a hospital setup. They prevent the indiscriminate injudicious use of antimicrobials.Designing an antibiogram by our
hospital lab will help dene local susceptibility trends and resistance patterns.
KEYWORDS
Empirical, broad spectrum, narrow spectrum, diagnostic tests, culture ,antimicrobials, infection
INTRODUCTION inammatory markers and general wellbeing. If the antimicrobial is to
Treatment of infection with antibiotics need an appropriate diagnosis be continued, regular reviews every 48 to 72 hours should be
rst. Initial therapy for infection is empirical guided by clinical undertaken to continue treatment, stop or change the antimicrobial and
presentation, It covers multiple possible pathogens --usually based on clearly documented. The patient must be switched from IV to oral
the most likely causative organism. The microbiological samples eg therapy when he is afebrile for more than 24 hours, clinically
(blood cultures, urine and sputum) should be taken prior to improving -signs and symptoms of infection and inammatory
commencing treatment, to guide targeted switches to alternatives that markers trending down towards normal,eating and drinking well, not
are better tolerated and more effective against the pathogen involved. suffering from certain deep seated risk infections such as( liver
Switching to narrow spectrum drugs reduces the cost and toxicity and abscess, osteomyelitis, septic arthritis ,meningitis ,endocarditis).
prevents the emergence of antimicrobial resistance in the community.
Identifying the causative organism is of paramount importance to Due to emerging antibiotic resistance due to irrational prescribing
determine the best course of treatment.Signs and symptoms can be pattern, there was felt a need to conduct a study in Govt Doon Hospital
misleading since most viral infections present similarly to bacterial to assess the criteria of choice of antimicrobials prescribed by
infections. High inammatory marker like procalcitonin indicate clinicians in different departments of the hospital. A questionnaire
severe bacterial infection whereas PCT is less likely to be raised in based on different criteria of choosing an antibiotic, was designed for
response to viral infections, autoimmune conditions. Infections are the clinicians to easily choose among the options. Also, some general
marked by increased leucocyte count, increased platelets, increased C questions were framed to assess the antibiotic prescribing practice
reactive protein, increased ESR, increased serum creatinine, liver guidelines in the hospital. The criteria of choice were P drug criteria
function tests. Danger signals as high temperature, hypotension, rapid –efcacy,safety, tolerability, cost of treatment ,patient factors--age,
pulse rate, high/low respiratory rate and altered mental state can comorbidity, previous allergy to a drug, sensitivity to an organism,
indicate sepsis. The microbiological tests used to conrm source of broad spectrum or narrow spectrum ,empirical,prophylactic or
infection are presence of organism, microscopy, culture, serology, denitive therapy, diagnostic tests—hematology, X ray, urine
polymerase chain reaction,antibiotic susceptibility testing. CSF microscopy, CSF, blood/urine culture. Also the results were tabulated
&urine microscopy are also used to detect infection. In addition to based on different criteria in all clinical departments.1-9
treating infections, antimicrobials can be used for long term
prophylaxis eg in recurrent UTI, surgical prophylaxis and as adjuvant
prophylaxis eg with some chemotherapeutic agents. Patients at MATERIAL METHODS
extremes of age (very young and very old), immunocompromised The study was carried out in various clinical departments (Medicine,
patients and patients with serious long-term conditions such as chronic Surgery, Gynecs&Obstetrics, Orthopedics, Pediatrics, ENT, ICU) in
kidney disease or liver failure, are at higher risk of serious infections Govt Doon Hospital situated in Patel Nagar, Dehradun ,afliated to
and are more likely to need antimicrobial treatment. The choice of Doon Medical College ,for a period of four months from January to
antimicrobials involves several factors like causative organism, April 2022. The two intern students were instructed to collect nearly
infection severity, local resistance patterns, drug interactions, patient 200 prescriptions from IPD from different clinical departments like
factors such as previous history of drug allergy, body weight and –Medicine, Sugery, Gynces, Pediatrics, ENT, Orhopedics, ICU.
hepatorenal function, local sensitivity patterns. In critically ill patients Nearly all the important cases prescriptions were covered in which
as in septic shock, febrile neutropenia and bacterial meningitis, antibiotics were prescribed. The consultants were given questionnares
empirical therapy should be started immediately after collection of of 21 questions(Appendix1) to answer appropriately the criteria of
diagnostic specimens. Patients who are stable and frequently ill for a choosing antimicrobials in a particular scenario. Some general
period of several days or weeks (eg subacute bacterial endocarditis and questions about the prescribing trend in the follow up in IPD were also
vertebral osteomyelitis /diskitis) before presentation, antibiotic put in the questionnaire. Any doubts regarding antibiotic use, were
therapy should be withheld until multiple sets of blood cultures or disk cleared by discussions with the consultants. The data was compiled by
space aspirate /or bone biopsy have been obtained. the students and tabulated. The permission for conducting the study
was taken by the Institutional ethical commitee.
After starting, an antimicrobial should be reviewed within 48-72 hours
to ensure that the initial diagnosis is still valid and the chosen RESULTS
antimicrobial remains appropriate. Response to the antimicrobials The criteria of choice as efcacy and availability was 100& cost was
should also be monitored by checking patient's temperature, important in case of medicine deptt.
International Journal of Scientific Research 1
Volume - 11 | Issue - 08 | August - 2022 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

Table 1 Obs & Gyn 40

DEPARTMENT No. of Cases Orthopedics 40
Medicine 40 ENT 20
Pediatrics 20
Surgery 40 Total 200
Table2:Medicine
Case Cause/ Causative Organism Treatment No. of Cases Antibiotics Prescribed on what basis
Acute Gastroenteritis Viral, Inj Ceftriaxone 1 gm 10 Broad spectrum
Entero-toxigenic & Entero- IV BD
pathogenic Inj Metronidazole
E. coli 100ml IV TDS
S. aureus,
B. cereus,
C. botulinum
Biliary tract Enterobacteriaceae (E.coli, Inj hepamerz or udiliv 4 Diagnostic tests –hematology
infection/Jaundice Klebsiella sp.)
Community acquired S. pneumoniae, Inj Amoxyclav 1.2gm 9 -Diagnostic tests –x ray,hematology
Pneumonia IV BD -Efcacy of drug
Typhoid Salmonella Typhi Inj Cefuroxime 1.5gm 3 --Against specic pathogen
IV BD or cexime --hematology –widal test
200mg bd or
azithromycin 500mg
od x 5 days
UTI Escherichia coli, Klebsiella Inj Piperacillin+Ta 3 Diagnostic tests --- hematology,urine
pneumonia, Proteus mirabilis, zobactam 4.5gm TDS microscopy ,Urine culture ,
Pseudomonas , Enterococcus after that 2.25gm TDS
sp.

Liver Abscess Polymicrobial Inj Ciprooxacin 2 -Tolerability of drug

500mg BD Diagnostic tests –hematology
Inj Metronidazole Blood culture
100ml IV TDS
Pulmonary Tb M. tuberculi HRZE 3 -bactericidal and bacteriostatic action
-Efcacy of drug
-Safety of drug
Diagnostic tests –X ray,hematology
Acute Bacterial S. pneumoniaeH.inuenzae, Inj Ceftriaxone 2 g IV 2 -Based on bacterial or viral etiology
Meningitis Neisseria meningititidis 12hourly
Dexamethasone 4 mg -CSF culture
BD. Diagnostic tests—CSF,Hematology
Acute bacterial S. pneumoniae Amoxyclav 1.2gm IV 5 Broad spectrum
exacerbation of COPD H. inuenzae BD -
M. catarrhalis
Total 40
Table3-ENT
Case Causative Treatment No. of Antibiotics Prescribed on what
organism/ Cause Cases basis
Chronic Otitis Media S. pneumoniae Amoxyclav 1gm IV BD 5 Diagnostic tests –hematology
H. inuenzae Morexella
catarrahalis For Pre and Post op care- Inj
Ceftriaxone 1gm IV BD
Chronic Mastoiditis Polymicrobial Inj Piptaz 4.5gm IV TDS 4 -Blood culture
Inj Meropenem 1gm IV TDS -Diagnostic tests –X ray,hematology
Neck Swelling with Polymicrobial Draining of abscess and pus 3 Diagnostic tests –X ray,hematology
abscess Prophylactic antimicrobial therapy- Blood culture
Inj Ceftriaxone 1gm IV BD
ENT Pre&Post op Inj Ceftriaxone 1gm IV BD 8 -Diagnostic tests –X ray, hematology, urine
Antimicrobial Therapy Inj Metronidazole 100ml IV TDS microscopy
Total 20

Table4:Obs/Gyn
Case Causative organism/ Cause Treatment No. of Cases Antibiotics Prescribed on what basis
Obstetric Sepsis during and Group A beta- haemolytic Inj Ceftriaxone 1gm 10 Broad spectrum before starting
after pregnancy Streptococcus; E.coli, anaerobes. IV BD denitive therapy
Inj Metronidazole Cost &availability
S. pyogenes, E. coli, 500mg IV TDS Send c/s always
S. aureus, S.pneumoniae, Diagnostic tests ---X ray,hematology
Methicillin-resistant S.aureus
(MRSA), C.septicum &
Morganella morgani
Septic abortion Bacteroides, Inj Ceftriaxone 2 Broad spectrum, c/s in sepsis always
Prevotella bivius, 1gm Diagnostic tests –hematology, urine
Group B, Group A IV BD microscopy

2 International Journal of Scientific Research

Volume - 11 | Issue - 08 | August - 2022 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

Streptococcus, Inj Metronidazole Metronidazole &clindamycin --Efcacy

Enterobactereaceae, 500mg IV TDS for anaerobes
C.trachomatis, Clindamycin in ICU
Clostridium
perfringens.
Surgical Obstetric Inj Ceftriaxone 8 Broad spectrum
1gm IV BD Diagnostic tests --Urine
Antimicrobial Inj Metronidazole microscopy,hematology
Prophylaxis (LSCS) 100ml IV TDS
-Efcacy of drug
Inj Amikacin -Safety of drug
500mg IV BD -Tolerability of drug
-Cost of treatment
Surgical Inj Ceftriaxone 5 Broad spectrum
Gynecological 1gm IV BD Diagnostic tests –hematology,urine
Antimicrobial Inj Metronidazole microscopy
Prophylaxis( TAH, 100ml IV TDSInj
LTO, TO) Amikacin
500mg IV BD
Pelvic Inammatory S. aureus, Kit 6(Tab 9 Syndrome management –kits according
Disease* Enterobacteriacae, Cexime 400mg to syndromes
gonococci, 1tab
gardenella Tab
Metronidazole
400mg-BD for 14
days
Tab Doxycycline
1gm-BD for 14
days)
Vaginal Polymicrobial Kit 2( Tab 6 Syndrome management
Discharge(Vaginitis)* Secnidazole 2gm Pap smear cultures
Tab Fluconazole
150mg)
Clindamycin vaginal
tablets for anaerobes
Skin infections after vaginal Augumetin oral and IV 2 Efcacy
hysterctomy ,surgical
infections and chest
infections
Premature rupture of Azithromycin or erythromycin Azithromycin or 2 Efcacy
membranes erythromycin
Total 40
*These cases were taken from Gynaecology OPD

Table5:Pediatrics
Dosage of all antibiotics given to children are calculated on basis of their weight
Cases Causative Treatment No. of Antibiotics Prescribed on what
Organisms/Causes Cases basis
Pneumonia S. pneumoniae, -Child above 2 months- 7 -Age
H.inuenzae, Legionella, Cefotaxime 100mg/kg -Efcacy of drug
E.coli, Klebsiella sp., /ceftriaxone /day x 5 days -tolerability due to adverse effects
S.aureus After 48 hrs
Gentamycin 7.5mg/kg /dose Diagnostic tests –X ray,hematology
hours if no improvement
we give meropenem or
vancomycin
Acute Gastroentritis Less than 5 years –rota Tab cexime 6 Associated with blood and mucus -antibiotic
with Diarrhoea + virus –no antibiotic In adolescents – inj against strain specic
Vomiting E. coli ceftriaxone & amikacin
Salmonella
Rheumatic Fever Group A Streptococcus Inj Benzathine Penicillin 1 -Against specic pathogen till 18 years
G20,000IU /dose Diagnostic tests –hematology
If Penicillin allergy give
Inj Amoxyclav Or
Oral Azithromycin
Bacterial Meningitis At birth –hemophilus Inj Ceftriaxone100mg/kg 2 Against specic pathogen
inuenzae ,Ecoli /day x 14 days Blood culture
2 months -2 years S. Diagnostic tests –CSF,hematology
pneumoniae
Epiglotitis H.inuenzae , S.pyogenes, Inj Ceftriaxone Or 1 Against specic pathogen
S.pneumoniae, Inj Cefotaxime Diagnostic tests –X ray ,hematology
S.aureus,viral
Typhoid Salmonella sps Inj Ceftriaxone- once fever 3 Against specic pathogen
resolves start oral Cexime Diagnostic test –Widal
Total 20
International Journal of Scientific Research 3
Volume - 11 | Issue - 08 | August - 2022 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

Table6:Surgery
Case Causative Organism/ Cause Treatment No. of Cases Antibiotics Prescribed on what basis
Appendicitis E.coli, K.pneumoniae, Inj ceftriaxone 1 g BD 4 --Efcacy of drug
Streptococcus, Enterococcus, +metronidazole 100ml 8 -Safety of drug
P.aeruginosa hrly -Tolerability of drug
Diagnostic tests—X ray,hematology
Cholecystitis Enterobacteriaceae (E.coli, Inj Cefuroxime 1.5 gm IV 3 Prophylactic
Klebsiella sp.) BD Efcacy
In Acute cases Diagnostic tests—X ray,hematology
Inj Meropenem 1gm IV
TDS
Peritonitis/ GI Enterobacteriaceae (E.coli, Inj Piptaz 4.5gm IV 4 Against gram negative &anaerobes
perforations Klebsiella sp.), Bacteroides TDS+metrogyl Diagnostic tests—X ray,hematology
(colonic perforation), or
Anaerobes Inj Meropenem(2nd line
drug) 1gm IV
TDS+metrogyl
Mastitis S. aureus Inj Amoxyclav1.2gm IV 2 Against gram positive organisms
TDS Diagnostic tests –hematology
+
Inj Metronidazole 100ml
IV TDS
Cellulitis Strep.pyogenes, S.aureus Inj Amoxyclav 1.2 g iv Blood culture
BD Diagnostic tests –hematology
Burns Strep pyogenes, Enterobacter Amoxyclav 1.2gm IV 3 To cover gram positive organisms
sp., TDS Blood culture
S. aureus, And dressing with Silver Diagnostic tests --- hematology,urine
S. epidermidis, Pseudomonas, sulfadiazine microscopy
fungi (rare)
Ulcers Amoxyclav &amikacin For gram positive and gram negative
organisms
Diagnostic tests—hematology
Necrotising Fascitis Streptococcus pyogenes, S. Inj Piptaz 4.5gm IV 6hrly 2 -for gram positive
aureus, anaerobes, + Diagnostic tests –hematology
Enterobacteriaceae Inj Clindamycin 600mg Blood culture
(polymicrobial) IV TDS
Surgical Pre and Post op Inj cefuroxime or 16 -broad spectrum
Antimicrobial ceftriaxone Diagnostic tests –X ray,hematology
Prophylaxis (Hernia,
Cholecystectomy)
Liver abscess Metronidazole Against amoebic liver abscess due to
anaerobes
In bacterial abscess – against gram
negative E.coli
UTI Nitrofurantoin or Ciplox Sensitivity to organisms
/norox
In refractory cases Tab
Rifagut 200 mf BD X 5
days.
Total 40
Table6:Orthopedics Table7:Antibiotic Resistant Cases
Surgical Antimicrobial Prophylaxis Out of 200 cases above some of the cases were antibiotic resistant for
Surgery Medication Antibiotics Prescribed on what basis which higher antimicrobials were given
Orthoped Inj Cefuroxime Broad spectrum Case Resistance Treatment No. of Cases
ic Inj P drug concept -Efcacy of drug against Osteomyelitis VRSA ( Vancomycin Inj 1
Surgery Metronidazole specic pathogen depending on c/s Resistance) Linezolide60
100ml -Safety of drug 0mg IV BD
IV TDS -Cost of treatment Ulcer (Bed Ampicillin, Amoxyclav, Inj Amikacin 1
Inj Amikacin Diagnostic ---X ray,hematology,urine Sores) Imipenem, 500mg IV
500mg IV BD microscopy Cefoperazone, BD
Patient factor --hepatorenal function Meropenem,
Pregnancy –avoid surgery, sent to Ceftriaxone,
gynecs to give safe medicine . Cefotaxime,
Total 37 Gentamycin
DISCUSSION
Case Causative Treatment No. of Antibiotics Prescribed The broad spectrum antibiotics prescribed were generally ceftriaxone,
organism cases on what Basis cefuroxime, cexime,cefaperazone and narrow spectrum antibiotics
Acute S.aureus, Inj 3 -against gram positive prescribed based on culture sensitivity were ciprooxacin,noroxacin,
osteomye Streptoc- Ceftriaxone staphylo infection metronidazole, gentamycin .The higher antibiotics prescribed in case
litis occus 1gm IV BD Also gram negative of sepsis were meropenem ,piperacillin tazobactam---both(against
pyogenes + bacteria on rise gram positive bacteria, gram negative bacteria ,common anaerobes) ,
Entero- Piptaz Pseudomoas and Ecoli vancomycin in methicillin resistant staphylococcus aureus.
bacteriaceae 4.5gm IV also Metronidazole &Clindamycin are administered for anaerobes. The
TDS Diagnostic tests –X clinicians comply with the standard treatment guidelines. Efcacy
ray,hematology &availability is the criteria in all cases .
4 International Journal of Scientific Research
Volume - 11 | Issue - 08 | August - 2022 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

Criteria of choice in Medicine Deptt- Based on diagnostic tests like aid in selecting empirical antibiotic therapy, and in monitoring
–X ray, hematology reports, Blood culture, CSF –the antimicrobials resistance trends over time within an institution. Antibiograms can also
are prescribed. Safety is also a criteria while administering anti be used to compare susceptibility rates across institutions and track
Tubercular drugs as Anti TB drugs are associated with liver enzymes resistance trends. The clinicians should be given training how to read
elevation, vestibular toxicity,retrobulbar neuritis. The doctors switch &interpret an antibiogram. Also the antibiotic consumption and
to alternative drugs in case of toxicity with any anti T.B drug. expenditure should be recorded in the hospital. All practicing
physicians should be able to use antimicrobial agents in a responsible
Criteria of choice in Surgery department- Broad spectrum drugs manner that is benecial to the individual patient and the community.
with bactericidal activity and concentration dependent killing were
preferred. In Operation theatre, culture sensitivity (c/s) is sent& drugs Acknowledgement –
with pharmacokinetic prole of time dependent killing drugs were I thanks all the consultants ofGovt Doon Hospital in giving their
given.In pregnancy Amoxycillin was preferred. The Fixed dose valuable time to answer the alloted questionnare and to clear any
combinations mostly chosen were piperacillin and tazobactam and doubts by discussion.
Amoxyclav and Norox TZ. The antibiotics were provided denitely
for dirty contaminated wounds and mostly in high-risk situations. Both REFERENCES
pre-and postoperative prophylaxis for surgical site infection were 1. The Pharmaceutical Journal, PJ, August 2021, Vol 307, No 7952; 307(7952) ::DOI:
10.1211/PJ.2021.1.95470
given. Metronidazole 100 ml 8 hrly was prescribed for anaerobic 2. National Institute for Health and Care Excellence. Antimicrobial stewardship: systems
organisms and Augumentin 1. 2 g IV TDS for skin infections against and processes for effective antimicrobial medicine use (NG15). 2015.https:
staphylococcus organisms. Cefaperazone and sulbactam combination //www.nice.org.uk/guidance/ng15 (accessed Jul 21).
3. Public Health England. Antimicrobial stewardship: start smart then focus.
- 1.5 gm IV B.D was given in hepatobiliary surgeries. 2015.https://www.gov.uk/government/publications/antimicrobial-stewardship-start-
smart-then-focus (accessed Jul 2021).
Criteria of choice in Orthopedics– Broad spectrum antibiotics were 4. Case-based learning: recognising sepsis. Pharmaceutical Journal Published Online
First: 2019. doi:10.1211/pj.2019.20207107
given in road trafc accidents and metronidazole infusion in farm 5. Case-based learning: recognising sepsis. Pharmaceutical Journal Published Online
injuries. Also, in operation theatre & all infective orthopedic First: 2019. doi:10.1211/pj.2019.20207107
conditions like osteomyelitis c/s is done to nd the antibiotic 6. Principles of initiating antimicrobial therapy and empiric prescribing. Clinical
Pharmacist Published Online First: 2016. doi:10.1211/cp.2016.2020150724
sensitivity. In old age where there is hepatorenal dysfunction --- 7. Antibiotics – uses. NHS. 2019.https://www.nhs.uk/conditions/antibiotics/uses/
cefaperazone 1 g IV adult dose is given and 500 mg IV in children. (accessed Jul 2021).
8. Olusoga A, Howard P, Atack K, et al. Antimicrobial stewardship in a large teaching
hospital: is the reassessment of intravenous antibiotics on our safety radar? The journey
Criteria of choice in Gynecs Obstetrics- The antibiotics are given so far. Amsterdam, Netherlands: 2019.43
stepping up from lower to higher antibiotics depending on the severity 9. Intravenous to Oral Antimicrobial Therapy Review and Switch (IVOS). Leeds Health
Pathways. http://nww.lhp.leedsth.nhs.uk/antimicrobials/IVOS.pdf (accessed Jul 2021).
of infection. First ceftriaxone &metronidazole are prescribed based on 10. ncbi.nlm.nih.gov
broad spectrum & efcacy. If it is not cured, the doctors switch to Inj
amoxiclav and gentamycin and metronidazole –Triple antibiotic
therapy.In case of sepsis ,stepping up to Injs Meropenem or
Piptaz(Tazobactam +Piperacillin) is done. In case of surgical site
infections – depending on results of microbiology test reports of
culture sensitivity of organisms, in case of suspecting any drug
resistance, antibiotics are given. Urine culture is done in early
pregnancy UTI, prolonged Foleys catheterisation. In case of Pelvic
inammatory disease &vaginitis ---syndrome approach is applied
giving treatment kits. In case of skin infections, the antimicrobial
treatment depends on the site of infection. In antenatal cases, the safer
drugs to be used are Inj ceftriaxone and metronidazole.

Criteria of choice in Pediatrics- Broad spectrum drugs were

prescribed in case of children instead of waiting for culture
sensitivity.Generally Inj Ceftriaxone/Amoxycillin were given
.Vancomycin was contraindicated in acute kidney injury. The
cephalosporins were avoided in cases with history of drug allergy. Also
Amoxyclav was substituted for penicillins in case of allergy. Also
sensitivity of the organism to the antibiotic also criteria to treat in
pediatrics diseases like in typhoid,meningitis.

Antibiotic prescribing pattern- The prescribers documented in the

medical record, the dose, duration and indication for all antibiotic
prescriptions. The appropriateness of all antibiotics was approved 48
hours after the initial orders. There was change from IV to oral therapy
in appropriate situations and while discharging. The dose adjustment
was done in case of renal dysfunction eg piperacillin tazobactam,
meropenem dose were halved. Also, dose optimization was done to
optimize the treatment of organisms with reduced susceptibility. Eg
topical use of drugs in skin infection.Time sensitive stop orders for
specic antibiotics were given like metronidazole for 5 days only, rest
antibiotics for 7 days ,no antibiotics in acute pancreatitis with normal
total leucocyte count. Also there are educational trainings provided to
clinicians through seminars, Medical education unit,
pharmacovigilance meetings ,to improve their antibiotic prescribing.
There is no current antibiogram distributed to prescribers at this
facility. Also, the facility does not monitor antibiotic consumption or
antibiotic expenditure.

CONCLUSION
The correct criteria of choice of antimicrobials and antibiotic
prescribing pattern help the hospital doctors in designing an antibiotic
stewardship programme. The hospital antibiogram should be
designed by the microbiology lab to give a periodic summary of
antimicrobial susceptibilities of local bacterial isolates. Antibiograms
should be used by clinicians to assess local susceptibility rates, as an
International Journal of Scientific Research 5

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