There of the prospective survey done in six

There are certain researches that have been made about
pattern of antibiotics usage in a hospital by professional individuals or
authorised organizations and government. As eloquently stated by one of the
prospective survey done in six Ministry of Health general hospitals in Malaysia
in 1990, study on “Pattern of Antibiotic Usage in Hospitals in Malaysia”, a
prospective, descriptive and cross-sectional survey of antibiotic prescriptions
discharged for inpatients at six public government-run hospitals located across
the country, an overall of 1,918 antibiotics prescription were obtained and
analysed for pattern and trend of usage. The hospitals of which the survey had
taken place have a vast number of beds available for inpatient patients ranging
in size from 800 to 1,000 beds (Lim, Cheong, & Suleiman, 1993).

Sample unit for this prospective study was an antibiotic
prescription whether the prescriptions was discharged for single agent alone or
a combination of multiple antibiotics. Target size of 350 prescriptions for
each hospital was fixed and prescription collection was to gather from several
departments as such; medicine (100), surgical department (100), obstetrics and
gynaecology (50), paediatrics (75) and intensive care unit (25). Each
department was demanded to organise data collection for every successive
antibiotic prescriptions from a selected date until the target number of
prescriptions was collected.  It was
discovered that about two-thirds of 1,918 antibiotics prescriptions were
intended for therapeutic purposes while 20% of stated therapeutic prescriptions
were based on microbiological test results. A total of 661 (36%) prescriptions
came directly from medical departments while 669 (35%) came from surgical
department (which include general surgery, orthopaedics, otorhinolaryngology
and ophthalmology), 344 (18%) were discovered from paediatrics clinics and 214 (11%
from obstetrics and gynaecology (Lim et al., 1993).

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A certain number of 34 different antibiotics per se or
in 136 various combinations were prescribed. These comprised of 7 group
penicillin, 5 group cephalosporin, and 4 group aminoglycosides and 2 group
tetracycline. Out of these, they were about 1063 (55%) single antibiotic
prescriptions and 855 (45%) prescriptions of different combination antibiotics.
In 705 (37%) of those, the prescriptions included two group of antibiotics; in
132 (7%), while precisely three antibiotics were prescribed and in 18 were more
than 3 antibiotics. Of all 34 antibiotics, ampicillin was the most frequent
antibiotic given to patient, being prescribed for as much as 798 (42%)
prescription. The intention of prescribing
antibiotics for therapeutic purpose was in 1263 (66%) prescriptions and 614
(32%) prescription for prophylactic purpose. Prophylactic antibiotics
prescriptions were regularly discovered in surgical and obstetrics and
gynaecology departments (Lim et
al., 1993).

Additionally, as mentioned before,
there were only 255 (20%) of the 1263 therapeutic prescriptions which were
based on microbiological test results. The microbiological tests which were performed
include cultures in 240 instances and serological­­ test in 9 prescriptions. Only 743 (59%) prescriptions involved taking culture prior
to treatment. About 131 (13%) of the 1008 prescriptions, the prescribers were
incapable to identified the specific infection-induced pathogen. Furthermore,
about 614 (32%) prescriptions were intended for antibiotic prophylaxis. Prophylactic
antibiotics prescriptions were regularly found from surgical and obstetrics and
gynaecology departments. Correspondingly, prescriptions for antibiotics
prophylaxis were more often involved combinations of antibiotics. However,
there was certain number of prescriptions which was about 41 which their
purpose was not specified.  In
conclusion, antibiotics and antibiotics regiments employed in the study have
shown a great variability in general. The study identified several evidences of
lack of compliance with guidelines on antibiotic use implemented by the
Ministry of Health in Malaysia (Lim et al., 1993).

There is also a study done in
Lebanon which relates to pattern of antibiotic usage, study on “Community Usage Pattern of Antibiotics within Lebanese Population: A Prospective
Study” by Malak
Khalifeh¹’², Nicholas Moore¹, and Pascale Salam²­ in Lebanon (¹University de
Bordeaux, Bordeaux, France. , ²Clinical & Epidemiological Research
Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon). This
study seeks to discover the usage pattern of antibiotics in Lebanon. The
prospective study was established in a community-based pharmacy setting in
Lebanon, using an organised random interview for patients that came to
community in search of antibiotics. Standard characteristics and reasoning for
taking self-medication were obtained while the usage pattern for the research
was described using Anatomical Therapeutic Chemical Classification/Defined
Daily Doses (ATC/DDD) system (Khalifeh, Moore, and Salameh, 2017).

The total participants in this study was
about 501, with the female being a majority as much as 69.5% of the total.
Among these participants, 314 (62.7%) demanded antibiotics without
prescriptions for their treatment while 187 (37.3) had a prescription for the
antibiotics. The most consumed antibiotic was Amoxicillin-clavunic acid
(coamoxiclav) (33.7%) as cephalosporin (21.2%) followed behind. Besides that,
the most common dispensed antibiotic without prescription was also coamoxiclav
(37.3%) while followed by cephalosporin (21%), penicillin (17.2%), macrolides (6.1%)
and fluoroquinolones (3.8%) correspondingly. On the other hand, the antibiotics
allotted with prescription were as the following ascending order: penicillin
(5.3%), macrolides (14.4%), fluoroquinolones (17.6%), cephalosporin (21.4%) and
coamoxiclav (27.8%). On a side note, 170 (33.9%) participants disclosed they
used antibiotics once annually. The mean for dispensation of antibiotics was
9.07 DDD for short term use which is less than fortnight (<2weeks). The mean of request per year was 3.35 which were significantly higher in patients without medical prescription than with prescription. Group of males were dispensed with more DDDs than group of females although the significant of the result was not high. Moreover, 25-50 years old patients had significantly taken and consumed more than 1 DDD daily (61.7%) unparalleled to patients with age higher than 50 years old  (41%). In conclusion, the study reveals that usage and consumption of antibiotic in Lebanon is not controlled, educational awareness programs should be executed to prevent unnecessary use and misuse of antibiotics (Khalifeh et al., 2017). Additionally, we take another look on study of antibiotic prescription pattern within Ghanaian population surrounding University of Cape Coast Hospital, Ghana. The study on "Antibiotic Prescription Pattern in a Ghanaian Primary Health Care Facility" by James Prah¹, Joseph Kizzie-Hayford¹, Emmanuel Walker¹, Adelaide Ampofo-Asiama¹ in Ghana(¹University of Cape Coast Hospital, University of Cape Coast, Ghana). This study is conducted to assess the pattern of antibiotic prescriptions and discover the use of standard treatment guidelines (STG) by health care practitioners primarily clinicians. The method of this prospective cross sectional study have made use indicators of seven core drugs that involved five prescribing and two patient care indicators . Sample size of this study was 388 voluntary participants who were recruited at outpatient pharmacy in the hospital (Prah, Kizzie-Hayford, Walker, Ampofo-Asiama, 2017). A figure of 388 patients with average age of 32.8 ~ 20.6 years old were involved in the study, 151 (39%) were males while the rest 237 (69%) were females. Out of all collected medical prescriptions issued to the patients, the study explored that 55.2% of the prescriptions contained prescribed antibiotics and the mean of number of medicines per prescriptions was 3.5, with amoxicillin (22.5) being the most prescribed antibiotics followed by ciprofloxacin (18.4%) and coamoxiclav (13.9%) (Prah et al., 2017). There was significant association between the knowledge of patients regarding their medication and the number of drugs per prescription (p = 0.002), age (p = 0.015) and educational level (p = 0.001). However, there was no significant association between sex of patients and their understanding of medications (p = 0.902). The study mentioned that a number of 40 (10.3%) patients we referred to perform test for diagnosis whilst 27 (12.6%) of the 214 patients who received antibiotics prescription were asked to perform investigations to confirm bacterial-induced infections. Most of the indication antibiotics prescription issued to patients were upper respiratory infections (29.9%), followed by urinary tract infections (19.6%), dental conditions (10.3%) and enteric fever (8.9%) (Prah et al., 2017). To sum up, the study concluded there is practice of polypharmacy and unreasonable drug use among prescribers therefore the pattern of antibiotics prescriptions analysed in the study was found to be generally not satisfactory. It is also known that there were recurrent use of antibiotics by clinicians and number of medications prescribed per encounter which is 3.5 which slightly above the ideal WHO standard of less than 2. This study may provide baseline data for others studies that may relate to investigation of why there is polypharmacy and recurrent antibiotics usage in the hospital pharmacy setting (Prah et al., 2017). Following, there is one other research made a couple of years ago on investigating pattern of antibiotics prescribing in a tertiary care hospital setting. The research on "Patterns of Antimicrobial Prescribing in a Tertiary Care Hospital in Oman" by Abdulrahman Al-Yamani¹, Faryal Khamis², Ibrahim Al-Zakwani³, Hamed Al-Noomani?, Jaleela Al-Noomani? and Seif Al-Abri²(¹Internal Medicine Resident, Oman Medical Specialty Board, Muscat, Oman.,²Department of Internal Medicine, Royal Hospital, Muscat, Oman., ³Department of Pharmacology and Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman., ?Department of Pharmacy, Royal Hospital, Muscat, Oman., ?Department of Nursing, Royal Hospital, Muscat, Oman.). The objectives of the study are to measure and make improvement of the antimicrobial utilisation so that optimal clinical outcomes can be achieved as well as reducing bacterial resistance. Subsequently, the aim of this study is to evaluate antimicrobial prescribing pattern for inpatients in acute care set and also review the relevance of antimicrobial usage among prescribers in a hospital setting in Oman. Method of the study implemented is conducting a retrospective audit of the relevance of prescribing antimicrobials to inpatients in acute care set in tertiary care hospital in Oman for a period of four-week from 1 November to 28 November 2012). The records of discharged patients were collected from the department databases in the hospital. Patients' data and medical prescriptions were evaluated by a consultant of infectious disease. The relevancies of antimicrobial use was reviewed, analysed, and adjudicated based on local standard guidelines and knowledge of the consultant (Al-Yamani, Khamis, Al-Zakwani, Al-Noomani, Al-Noomani and Al-Abri, 2015). Results in the study reveals there were about 178 patients who discharged from acute care medical teams during the period. One hundred and fourteen (64%) patients received a figure number of 287 antimicrobial drugs during admittance to acute care wards. The mean of antimicrobials prescribed per encounter was 2.5 to 1.1. The most frequent antimicrobial drugs issued in prescriptions were piperacillin/tazobactam (21.8%) followed by both amoxicillin-clavunic acid and clarithromycin (19.5%). Piperacillin/tazobactam was regularly prescribed for community-acquired pneumonia (CAP), urinary tract infection (UTI), wound-site infection and others. Out of the 287 antimicrobial agents, 87 (30.3%) were indicated for CAP per se followed by UTI (13.9%). Cultures were collected ahead of time before issuing antimicrobial prescriptions in 25% of infection. Most of the infections were caused by gram-negative bacteria and beta-lactamase producing organism. Inconsistency in selection of antimicrobial for typical infections was observed and noted. Succinctly, 114 (64%) patients had been given antimicrobial treatment during admission. Antimicrobial agents were prescribed empirically by prescribers before culture results become available, only 12% of antimicrobial treatments were adjusted accordingly after the results were obtained. The study has recognised a need for national guidelines for better management of regular infections so that inappropriate overuse and misuse of antimicrobial medications in tertiary care hospitals can be reduced (Al-Yamani et al.,2015).

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