A Prospective Observational Study on Drug Utilization Patterns, Rationality Assessment, and Adverse Drug Reaction Monitoring of Antimicrobial Agents Prescribed in the Intensive Care Unit of a Tertiary Care Teaching Hospital

 Sai Kiran, M. Lakshmi Devi

Department of Pharmacy Practice, JSS College of Pharmacy Mysuru, Mysuru, India

Abstract

Background: In Intensive Care Units (ICUs), antimicrobial agents rank among the most commonly prescribed medications due to the frequent occurrence of severe infections, sepsis, and critical illnesses. Nonetheless, factors such as irrational prescribing, empirical treatment, polypharmacy, and the absence of antimicrobial stewardship play a major role in the development of antimicrobial resistance (AMR), escalating healthcare expenses, and causing adverse drug reactions (ADRs). Conducting drug utilization research within ICU environments is crucial for analyzing prescribing trends, evaluating the rationality of antimicrobial usage, and tracking ADRs to guarantee safe and effective pharmacotherapy.

Objectives: The objective of this study was to analyze the patterns of antimicrobial drug use, evaluate the appropriateness of antimicrobial prescriptions based on established guidelines, and track the occurrence and nature of adverse drug reactions in the ICU of a tertiary care teaching hospital.

Methods: Over a span of six months, a prospective observational study took place in the ICU of a tertiary care teaching hospital. The study included all adult patients admitted to the ICU who were administered at least one antimicrobial agent. Information regarding patient demographics, diagnoses, antimicrobial prescriptions, dosages, administration routes, treatment durations, culture sensitivity results, and adverse drug reactions (ADRs) was gathered using a predesigned case record form. The analysis of antimicrobial use employed the WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology, DU90% segment analysis, and WHO prescribing indicators. The rationality of prescriptions was evaluated against standard treatment guidelines and culture sensitivity findings. ADRs were assessed using the Naranjo causality assessment scale and the Hartwig severity scale.

Results: A total of 300 patients participated in the study, with a higher proportion being male (60%). Sepsis was the leading reason for prescribing antimicrobial therapy, accounting for 35%, followed by pneumonia at 25%. Beta-lactam antibiotics, particularly ceftriaxone and piperacillin-tazobactam, were the most frequently used antimicrobials. On average, each patient received 2.3 ± 1.1 antimicrobials. The DDD/100 bed-days analysis indicated significant use of ceftriaxone (28.5), piperacillin-tazobactam (20.1), and meropenem (15.7). About 28% of the prescriptions were deemed irrational, primarily due to empirical use without culture confirmation and inappropriate treatment duration. The incidence of adverse drug reactions was 12%, with gastrointestinal issues and nephrotoxicity being the most prevalent reactions.

Conclusion: The research indicated extensive use of broad-spectrum antimicrobials and a significant number of irrational prescriptions in ICU environments. To encourage rational antimicrobial use and reduce resistance and negative outcomes, it is essential to conduct regular prescription audits, implement antimicrobial stewardship programs, and monitor adverse drug reactions.

Keywords

Study of Drug Use; Intensive Care Unit; Agents for Antimicrobial Use; Evaluation of Rationality; Reactions to Adverse Drugs; ATC/DDD; Stewardship of Antibiotics; Monitoring of Drug Safety.