Evaluation of Antimicrobial Utilization and Prescribing Practices in an Inpatient Medicine Department: A Prospective Observational Study

Abstract

Inappropriate antimicrobial utilization is an important contributor to the emergence and spread of antimicrobial resistance (AMR). Assessment of prescribing practices at the institutional level can identify inappropriate patterns and provide opportunities for antimicrobial stewardship interventions. Drug utilization studies are therefore useful for evaluating antimicrobial selection, route of administration, spectrum of activity and adherence to rational prescribing principles. Objectives: To assess the pattern of antimicrobial utilization among patients admitted to the Medicine department of a tertiary care hospital; to evaluate prescribing practices using WHO drug-use indicators; to determine the proportion of empirical and culture-guided antimicrobial therapy; and to assess the utilization of broad- and narrow-spectrum antimicrobial agents. Methods: A prospective observational study was conducted in the Department of Medicine of a tertiary care teaching hospital for six months. Adult patients aged 18 years and above who received at least one antimicrobial during hospitalization were included. Prescriptions from intensive care units and other specialty departments were excluded. Data regarding demographic characteristics, diagnosis, antimicrobial class, number of antimicrobials, route of administration, generic or brand prescribing, culture sensitivity-based treatment and inclusion in the Essential Medicines List were collected using a structured proforma. Broad- and narrow-spectrum antimicrobials were classified according to the WHO AWaRe framework. Data were analyzed using descriptive statistics. Results:A total of 400 antimicrobial-containing prescriptions were evaluated. Patients aged 46–60 years constituted the largest age group (31%), and males represented 59% of the study population. Respiratory tract infections were the leading indication for antimicrobial therapy (33%), followed by urinary tract infections (21%). Cephalosporins were the most frequently prescribed antimicrobial class (31%). Intravenous administration was used in 62% of prescriptions. Broad-spectrum antimicrobials accounted for 67% of prescriptions. Culture and sensitivity-guided therapy was documented in 28%, whereas 72% of prescriptions were empirical. Generic prescribing was observed in 42% of prescriptions, while 78% of antimicrobials were from the Essential Medicines List. The mean number of antimicrobials per prescription was 1.46.Conclusion: The study demonstrated substantial use of broad-spectrum and empirical antimicrobial therapy, together with relatively limited culture-guided and generic prescribing. Strengthening antimicrobial stewardship, microbiological support and adherence to standard treatment recommendations may improve the quality and rationality of antimicrobial utilization.