Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 10 ( 2018 ) > List of Articles


A multicentric, prospective, observational antibacterial utilization study in Indian tertiary referral centers

Jigeeshu V. Divatia, Nitin Mali, Siddharth P. Deshpande, Niteen D. Karnik, Nithya J. Gogtay, Renuka P. Munshi, Sanjay C. Wagle, Kannan Sridharan

Keywords : Antibacterial resistance, antibacterials, indicators, medical intensive care unit, public and private hospitals

Citation Information : Divatia JV, Mali N, Deshpande SP, Karnik ND, Gogtay NJ, Munshi RP, Wagle SC, Sridharan K. A multicentric, prospective, observational antibacterial utilization study in Indian tertiary referral centers. Indian J Crit Care Med 2018; 22 (10):723-729.

DOI: 10.4103/ijccm.IJCCM_197_18

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Rationale: Antibacterials are largely prescribed to the intensive care unit (ICU) patients due to high prevalence of infections. However, appropriate use of antibacterials is imperative; since the misuse of antibacterials increases antibacterial resistance and ultimately, it has negative impact on health care and economic system. Hence, continuous antibacterials prescription assessments are very important to judge and improve prescription patterns. The present work was carried out at public and private hospitals to assess the differences in antibacterial prescribing pattern. Methods: The present study was conducted at three public and two private hospitals over the period of 14 months. Demographic and drug use details were captured daily from patients admitted to medical ICUs to assess the World Health Organization indicators. Results: A total of 700 patients were enrolled across the five centers (140 per center), among them 424 were male and 276 were female. Average number of drugs and antibacterials prescribed at public hospitals are significantly higher than the private hospital. However, percentage of antibacterial agents prescribed at public hospitals was significantly lower than the private hospitals (P = 0.0381). Private hospitals had significantly lower percentage of antibacterial agents prescribed by generic name (P < 0.0001). Differences in change of antibacterial agents required were not statistically significantly different (P = 0.1888); however, significant difference was observed in percentage of patients who received antibacterial treatment as per sensitivity pattern (P = 0.0385) between public and private hospitals. Significantly higher mortality was observed in public hospitals compared to private hospitals (<0.0001). Conclusions: More generic prescriptions and more number of prescriptions as per the sensitivity pattern are required at each public and private hospital.

PDF Share
  1. Venkataraman R, Divatia JV, Ramakrishnan N, Chawla R, Amin P, Gopal P, et al. Multicenter observational study to evaluate epidemiology and resistance patterns of common Intensive Care Unit-infections. Indian J Crit Care Med 2018;22:20-6.
  2. Ravi KP, Durairajan S, Parivar S, Venkataraman R, Ramasubramanian V, Ramakrishnan N. Epidemiology of Intensive Care Unit infections and impact of infectious disease consultants in managing resistant infections. Am J Infect Dis 2013;9:30-3.
  3. McKenzie C. Antibiotic dosing in critical illness. J Antimicrob Chemother 2011;66 Suppl 2:ii25-31.
  4. Gangwar A, Kumar N, Kothiyal P. Antibiotic prescription and cost patterns in an Intensive Care Unit: A review of literature. Pharm Innovation 2012;1:68-72.
  5. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res 2011;134:281-94.
  6. Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, et al. Intensive care in India: The Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 2016;20:216-25.
  7. Srishyla MV, Mahesh K, Nagarani M, Mary CS, Andrade C, Venkataraman B. Prescription audit in an Indian hospital setting using the DDD (Defined Daily Dose) concept. Indian J Pharm 2016;26:23-8.
  8. Orsi GB, Ciorba V. Vancomycin resistant enterococci healthcare associated infections. Ann Ig 2013;25:485-92.
  9. Ah Y-M, Kim A-J, Lee J-Y. Colistin resistance in Klebsiella pneumoniae. Int J Antimicrob Agents 2014;44:8-15.
  10. World Health Organization. Introduction to Drug Utilization Research. World Health Organization; 2003. Available from: [Last accessed on 2017 Dec 27].
  11. Camins BC, King MD, Wells JB, Googe HL, Patel M, Kourbatova EV, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: A randomized controlled trial. Infect Control Hosp Epidemiol 2009;30:931-8.
  12. Gautam CS, Saha L. Fixed dose drug combinations (FDCs): Rational or irrational: A view point. Br J Clin Pharmacol 2008;65:795-6.
  13. World Health Organization. How to Investigate Drug use in Health Facilities: Selected Drug Use Indicators. World Health Organization; 1993. Available from: [Last accessed on 2018 Jan 08].
  14. World Health Organization. How to Investigate Antimicrobial Use in Hospitals: Selected Indicators. World Health Organization; 2012. Available from: [Last accessed on 2018 Jan 08].
  15. Hussain M, Syed N, Shobha JC. Prescription patterns of antibiotics in acute medical care units of a tertiary care hospital in India. Int J Curr Microbiol App Sci 2014;5:673-679
  16. Pandiamunian J, Somasundaram G. A study on prescribing pattern of anti microbial agents in the medical Intensive Care Unit of a tertiary care teaching hospital in Puducherry union. Int J Pharm Pharm Sci 2014;6:25.
  17. Ansari AA, Khan MA, Khan JA, Hariz ML. Antibiotic prescription patterns in an Intensive Care Unit in the Kingdom of Bahrain: An observational prospective study. Int J Sci Res 2013;2:371-4.
  18. Badar VA, Navale SB. Study of prescribing pattern of antimicrobial agents in medicine Intensive Care Unit of a teaching hospital in central India. J Assoc Phys India 2012;60:20-3.
  19. Hug BL, Rossi M. A year's review of bacterial pneumonia at the central hospital of Lucerne, Switzerland. Swiss Med Wkly 2001;131:687-92.
  20. Curcio D; Latin American Antibiotic Use in Intensive Care Unit Group†. Antibiotic prescriptions in critically-ill patients: A Latin American experience. Ann Med Health Sci Res 2013;3:220-8.
  21. Hanssens Y, Ismaeil BB, Kamha AA, Elshafie SS, Adheir FS, Saleh TM, et al. Antibiotic prescribing pattern in a medical Intensive Care Unit in Qatar. Saudi Med J 2005;26:1269-76.
  22. Paruk F, Richards G, Scribante J, Bhagwanjee S, Mer M, Perrie H. Antibiotic prescription practices and their relationship to outcome in South African Intensive Care Units: Findings of the prevalence of infection in South African Intensive Care Units (PISA) study. S Afr Med J 2012;102:613-6.
  23. Sireesha GB, Tiwari P, Gombar S, D'Cruz S, Sachdev A. Antimicrobial utilization in multidisciplinary Intensive Care Units of a public tertiary care hospital. J Pharm Pharm 2014;5:252-4.
  24. John LJ, Devi P, Guido S. Drug utilization study of antimicrobial agents in medical Intensive Care Unit of a tertiary care hospital. Asian J Pharam Clin Res 2011;4:81-4.
  25. Mahajan B, Kaushal S, Chopra SC. A drug utilization study of antimicrobial agents (AMAs) in the Intensive Care Units (ICUs) at medical college hospital of North India. JK Sci 2013;15:129-32.
  26. Luciana T, Andrajati R, Rianti A, Khan AH. Rational antimicrobial use in an Intensive Care Unit in Jakarta, Indonesia: A hospital-based, cross-sectional study. Trop J Pharm Res 2015;14:707-14.
  27. Cuthbertson BH, Thompson M, Sherry A, Wright MM, Bellingan GJ; Intensive Care Society, et al. Antibiotic-treated infections in intensive care patients in the UK. Anaesthesia 2004;59:885-90.
  28. Shrikala B, Kranthi K, Nafisa. A Prospective study on evaluation of antibiotic prescription practices in an Intensive Care Unit of a tertiary care hospital. J Clin Diagn Res 2010;4:3387-91.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.