AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Hashem Mohammed Mansour, MSc clinical pharmacist, Indonesian Hospital-Gaza
Citation: Hashem Mohammed Mansour (2022). Evaluation of six widely Prescribed Antibiotics using ATC/DDD method in the Indonesian Hospital in Palestine: Retrospective study. J. General medicine and Clinical Practice. 5(1); DOI:10.31579/2639-4162/056
Copyright: © 2022 Hashem Mohammed Mansour, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 29 October 2021 | Accepted: 28 December 2021 | Published: 05 January 2022
Keywords: antibiotic; defined daily dose; appropriate use; resistant; vancomycin
Purpose: The aim of this study to measure consumption of AB in ICU and medical department using defined daily dose which is an accepted standard method and provide data for rational use of antibiotics to decrease morbidity, mortality and resistance.
Methods: The study was a retrospective in a state hospital with 120 beds. All patients treated with specific antibiotics on 1st December 2019 until 1st March 2020 were included in the study. Indications for antibiotic use and information about the patients were recorded on special forms. Antibiotic use were evaluated using the ATC/DDD index, which is also suggested by the WHO to be used in similar studies.
Results: 234 patients were admitted to the medical and ICU department hospital, of whom 46 patient in the ICU. 96% OF the patients in ICU received AB and 92% of the patients in the medical department received AB. Those identified to use antibiotics with appropriate indications 40.7% in the medical department and 65.5% in the ICU department. The mean hospital stay was 3.4 days, of the total patients 42% of patient received AB less than three days.
Conclusion: The rate of consumption of antibiotics is very high in our hospital and most of the prescribed drugs were irrational. Antibiotic stewardship should be constructed and activated in our country to control AB use, as this will decrease the emergence of resistant strains and decrease budget in hospitals and on the patients.
Antibiotics (AB) drugs are the most popularly prescribed in our country with the absence of anti-biotic stewardship to control these medications [1,2]. Irrational use of the AB associated with the emergent of resistant strains of bacteria, adverse effects and increase treatment burden [3-5]. Rationale use of antibiotic with improving policies result in better outcome with less side effects and cost effectiveness [6,7]. Globally there is an increase in anti-biotic consumption resulting in increased morbidity and mortality but it helps developing an antimicrobial stewardship program and increase awareness of resistance, adverse drug reaction and drug interaction of antibacterial drugs [8,9]. A systematic review found that the highest consumption of anti-biotic was in the intensive care unit at western European hospitals [10]. A study conducted in Germany found that there is increase in AB prescription beyond the second day which result in increased clostridium difficile infections [11]. There was a statistically significant association between consumption of antimicrobials and resistance of Escherichia coli isolates to quinolones, while for Klebsiella pneumoniae, there was a statistically significant association between the resistance rates and consumption of gentamycin, ceftazidime and meropenem [12]. In turkey there was difference between AB consumption between the hospitals due to the absence of antibiotic stewardship with low consumption in teaching hospitals, also in Europe there is increasing consumption of AB in the outpatient clinic [13,14]. Data on in-hospital antimicrobial use vary widely not only due to different antibiotic policies at different institutions but also due to different methods of measures. Adherence to the standard of reporting the methods of measurement is warranted for benchmarking and promotion of rational antimicrobial use [15]. Our review confirms the large variation in antibiotic use even across similar settings and providers, the Italian-speaking region showed a significantly higher consumption density, followed by the French- and German-speaking regions while in acute care hospitals in Switzerland have a relatively low consumption in intensive care units [15,16]. Data from low- and middle-income countries are under-represented, in addition, the heterogeneity of reported measures clearly shows that there is need for standardization [17]
The aim of this study to measure consumption of AB in ICU and medical department using ATC/DDD index and provide data for rational use of antibiotics to decrease morbidity, mortality and resistance.
The study was a retrospective conducted in the Indonesian teaching Hospital with 120 beds. The data of this study were obtained from departments of internal medical department that includes (internal medicine, chest diseases, cardiology, infectious diseases), and intensive care units (cardiology, internal medicine). Data concerning antibiotic use in the hospital were collected on the 1st of December 2019 to 1st March 2020 by clinical pharmacist. All patients receiving antibiotics were included to the study. Data were collected from patient charts using a standard form; patients personal information, underlying disease, the name of the antibiotic in use, dosage, duration, reason of antibiotic use (prophylaxis, empirical, microbiologically proven infection) and microbiological test results were recorded on the form. Patients matching all criteria were accepted as “suitable”, and in the absence of even one criteria the patient was “non-suitable” excluded.
The existence of an infectious disease was detected by evaluating patient’s clinical complaints, physical examination findings and laboratory findings all together.
Study population
Patients who received parenteral ceftazidim, vancomycin, ciprofloxacin, cefotaxim, ceftriaxone, and amikacin from December 2019 to March 2020 were enrolled in this study. The data extracted from Hospital information system included record number of patients who received study drugs, Clinical data retrieved from patient charts.
Data collection
Patient’s data including, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. Drug’s indicator including treatment regimen, dosing, microbiological culture/sensitivity testing. Clinical outcome and adverse drug reaction verified as study outcome.
Defined Daily Doses (DDDs) The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. It calculated separately for every antibiotic, the average maintenance dose for an adult weighing 70 kg is prepared in main indications and the active substance should be taken as grams (or I.U.)[18]. In this calculation method, the form used is the ratio of the total DDD per 1000-bed-days. Also, the antibiotic consumption index of a country or geographical area at a certain period of time is calculated by DDD per 1000 people. In this study, DDDs of anti-infective agents are listed for systemic use according to ATC/DDD 2010 Index. DDD= (DDD*1000)/number of days
The study conducted in the Indonesian hospital-Gaza. Data concerning antibiotic use in the hospital were collected on the 1st of December 2019 to March 2020 by clinical pharmacist.
The total number of patients included in this study was 234 with total hospital stay 573 days. Those patients on the drugs mentioned above were included despite the medical illness as diabetes with the exception those with acute or chronic kidney disease excluded. The mean age of the patients was 60± 15. Of the patients included to the study, 112 were male (48%) and 123 were female (52%) see (Table 1) patient characteristics. All the patients, received antibiotics for any reason as empirical antimicrobial therapy none of them received antibiotics based on microbiological data. There was 46 patient were ICU and the remain internal.
When evaluating the 234 patients using antibiotics,42.7% were evaluated as “appropriate” in the medical department and 65.5% in the ICU. According to the microbiological data, none of patients receiving antibiotics in both departments based on culture sensitivity. The rate of antibiotic use in the departments for internal diseases was 92%, and in the intensive care units 96% (Table 2). While the highest rate of antibiotic use in the departments for internal diseases was in the department for pulmonary disease 30.3%, in infectious diseases 30% the lowest rate was found to be in the cardiology with 4.3% and the neurology clinic with 9.4%. (Table 2).
The mean duration was 3.4 days (minimum 1, maximum 13 days). Duration of treatment based on the number of days (14.7% one day, 26.9% two days, 19.2% three days,26.2% five days, 6.4% nine days and 4.5% more than 10 days), respectively(Table 3).
The third generation cephalosporin's were the mostly prescribed drugs.In our study, cephalosporin's were found to be the most frequently used antimicrobials among all antibiotics, with a rate of 84.6%. Among the cephalosporin's, 3rd generation cephalosporin's was the most commonly prescribed, Flouroquinolones were the second preferred after cephalosporins. For those in the medical department most frequently preferred 3nd generation cephalosporins was (ceftriaxone) in addition to fluoroquinolones, while in the intensive care units 3rd generation cephalosporins notably ceftazidim in addition to vancomycine(Table 4).
Antibiotic prescription differ between countries and hospitals in the same country. This difference depends on the diseases and epidemiology of infectious disease in this country. The absence of antibiotic protocols and policies or the absence of antibiotic stewardship can result in catastrophic emergence of antimicrobial resistance. Antibiotics does not only diverse between countries, but also diverse between the hospitals of a same country. Sometimes physicians preferences and differences in educational and health systems participate in this problem [19]. Antimicrobial agents are the most frequently used drugs in Palestine and they after none steroidal anti-inflammatory drugs. With the absence of data about AB consumption rate, the author estimate nearly 90% of our in-hospital patients receive AB.
In our study, the percent of prescribed antibiotics in the ICU department was 96% and the medical department 92% which is very high compared to other countries. In Europe antibiotic prescription range from 16 to 25% [20] while in turkey it is higher between 50 -60% [21].
In this study there was zero of antibiotics prescribed based upon culture sensitivity and the highest antimicrobial drugs prescribed for pulmonary disease 30.3% in the medical department and 41.6% I.C.U department.
The infectious disease represent 30% in the medical dept., and 20.6 in the I.C.U. while the lowest prescription of antibiotics was cardiology in both departments, other indication such as organ phosphorous poisoning 18% in the internal department and 16 I.C.U (Table)]. High rate of anti-microbial prescription in pulmonary disease is irrational since most of asthma patient and upper respiratory tract infections are viral. When evaluating the duration of antibiotic therapy it was as follow (14.7% one day, 26.9% two days, 19.2% three days,26.2% five days, 6.4% nine days and 4.5% more than 10 days), this mean 41.3% have only two days anti biotic in other words it was not necessary since anti biotic needs more than two day to produce its effect. This mean none scientific or irrational use of antibiotics, while those take four days of treatment (have benefit of antibiotic administration) was 40% see (Table 3). The mean duration of antibiotics was found to be 3.4
The results of our study clarify that there is irrational of antibiotic prescription and reflects the important of construction of antibiotic stewardship for controlling these medications based upon scientific way.
There were some limitations of this study as it was conducted in a single referred center with a small sample size. However, the accuracy of data give strength to the results and make the study more representative of the patients on antibiotics and make it a real world in our region.
The authors did not receive support from any organization for the submitted work.
The authors have no conflicts of interest to declare that are relevant to the content of this article.
All the data and materials as well as software application or custom code support their published claims and comply with field standards.
The study have ethical approval from Helsinki Committee on 7/10/2019.
Approval Number PHRC/HC/614/19.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
