Indo American Journal of Pharmaceutical Research, 2016 ISSN NO: 2231-6876

STUDY ON PRESCRIPTION PATTEN OF ANTIBIOTICS ON BRONCHOPNEUMONIA IN A

TERTARY CARE TEACHING HOSPITAL- AN OBSERVATIONAL STUDY
1 1 1 2 3
Dr. Stimson Jose , Dr. Eldho Mathew Paul , Dr. Benson Koshy , Dr. Basvanthappa SP , Dhivya Jose
1
Department of Pharmacy Practice, SJM College of Pharmacy, Chitradurga, Karnataka,
India. 2Department of Pediatrics, BMCH & RC, Chitradurga, Karnataka, India.
3
Department of Pharmacy Practice, National College of Pharmacy, Manassery, Kerala, India.
ARTICLE INFO ABSTRACT
Article history Bronchopneumonia is the inflammatory condition of the lung which mainly affects the
Received 10/09/2016 alveoli, the microscopic air sacs. It is one of the leading causes of death in the world. The
Available online present observational study aims to identify antibiotic prescription patterns and the average
30/09/2016 hospital duration of the paediatric inpatients in the department. A total of 120 inpatients
fulfilling the inclusion criteria were included in the study. The Current diagnosis, treatment
Keywords chart, length of hospital stay on admission to discharge were recorded and analyzed. In this
Bronchopneumonia, study males are more as compared to females with similar severity of illness and the
Hospital Duration, maximum number of patients (45%) comes under the age group of 12-24 months. Study
Antibiotic Prescription states that the maximum number of patients (58.33%) admitted with severe pneumonia
Pattern. followed by very severe and mild pneumonia. We also observed that most of the patients
(42.4%) stayed in the hospital for a period of 6-8 days and majority of them was on dual drug
therapy. We also found that cephalosporins are the most commonly prescribed antibiotic for
the management of bronchopneumonia, mostly given by intravenous route and Prescriptions
are mainly ordered in Brand names. The present study provides an overall pattern of
antibiotic usage in patients admitted with bronchopneumonia.
Corresponding author

Dr. Stimson Jose

Edamanassery (H)
Koombara Bazar Po
Calicut.673604
8943470110
stimsonjo@gmail.com

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Please cite this article in press as Dr. Stimson Jose et al. Study on Prescription Patten of Antibiotics on Bronchopneumonia in A
Tertary Care Teaching Hospital- an Observational Study. Indo American Journal of Pharmaceutical Research.2016:6(09).

Copy right 2016 This is an Open Access article distributed under the terms of the Indo American journal of Pharmaceutical
Research, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Vol 6, Issue 09, 2016. Dr. Stimson Jose et al. ISSN NO: 2231-6876

INTRODUCTION
Bronchopneumonia or lobular pneumonia is an infection of the terminal bronchioles that extends into the surrounding alveoli
resulting in patchy consolidation of lungs. The condition is particularly frequent at the extremes of life (i.e. in infancy and old age)[1].
The etiological factor includes age, source of infection and underlying host defects etc. In pre-school children, viruses are the most
common etiological factor and also more than one causative agent can be identified in many cases[2]. 2,500 years ago Hippocrates,
the father of medicine described about Pneumonia and the founder of modern medicine, Dr. William Osler who studied about
pneumonia all the way through his career and call pneumonia as the captain of the men of death[3]. Before the introduction of
antibiotics, i.e. in 1930s Pneumonia was the third-leading cause of death in the United States. In 2006, it was the eighth-leading cause
of death, accounting for about 55,000 deaths[1] and it is the number one cause of death from infectious diseases in the United States.
Pneumonia is the leading cause of mortality in the age groups under five years, affects 156 million children and more than two million
annual deaths occurs every year across the globe mainly in the developing countries[4]. India also carries the largest burden of
morbidity and mortality, accounting for about 43 million cases of the disease and 0.4 million deaths per year. The median of incidence
of pneumonia in India is approximately per year around 0.37 episodes per child. Datas according to World Health Organization
indicates worldwide, respiratory infections leads to more deaths in children than any other cause[4] .It also cause huge financial
burden. In the United States alone, total medical expenditures and indirect costs attributed to pneumonia amounted to more than $40
billion in 2005[3].
Antibiotics are the key drug in the treatment of infections. UNICEF/WHO report on pneumonia estimates suggests that if
antibiotic treatment were universally delivered to children with pneumonia, around 600,000 lives could be saved each year. [3] The
cause of morbidity and mortality associated to pneumonia is associated with misdiagnosis, mistreated, and underestimation[5].
Fortunately, most of the deaths attributable to pneumonia can be prevented by early diagnosis, usage of appropriate antibiotics, timely
referral, monitoring and follow-up[4].On the other hand, inappropriate antibiotic use, lead to Antibiotic resistance amongst the
common pneumonia causing bacteria is being reported frequently worldwide, including India(Streptococcus pneumonia and
Haemophilus influenza B) [4].It leads to wastage of healthcare resources, and exposing patients to risk of adverse effects. Thus these
current scenario of Under-utilization and misuse of antibiotics need to be addressed. Thus the morbidity and mortality due to
pneumonia can be reduced. For the above reasons, prescribing patterns need to be evaluated and modified if needed to make the
treatment more rational.

METHODS
The present observational study conducted at Department of Paediatrics, Basaveshwara medical college and hospital,
Chitradurga during the period of October 2015 to March 2016. A total of 120 paediatric in patients treated with Bronchopneumonia
aged less than 18 years fulfilling the inclusion criteria were included in the study. Inclusion criteria consist of children with
Bronchopneumonia admitted & prescribed with antibiotics in the department of paediatrics, both genders and who willing to give
inform consent form and those patientswho were not prescribed with antibiotics, outpatients and Patients with immunosupression
were excluded from the study. After fully explaining the study procedure written informed consent was obtained from
parents/guardians of all the children. . The patients who satisfy the above criteria are enrolled in the study. Institutional ethical
committee of our hospital approved the study. Using a well designed data collection form, patients are followed throughout the period
of hospitalization and obtained information on demographics of the patient including Name, Age, Sex, Occupation, Socio-economic
status and the data regarding diagnosis, drugs, route of administration, changes in therapy/withdrawal of antibiotic or addition of other
antibiotics (if any), hospitalization period of patients and cost of the antibiotics (in terms of MRP-Indian Rupees). The data thus
obtained was compiled and analyzed using Microsoft Excel 2010 for windows.

RESULTS
Description of patients according to gender
Out of 120 samples enrolled in our study, 53.3% are males and 46.6% are females as shown in figure 1.

Description of patients according

to gender
male female

47%
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53%
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Figure 1: description of patients according to gender.

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Vol 6, Issue 09, 2016. Dr. Stimson Jose et al. ISSN NO: 2231-6876

Description of patient according to Age

As mentioned in the table 1, We classified the patients according to age into four categories and found that maximum number
of patients (45%) comes under the age group of 12-24 months followed by <12 months (31.6% patients). 17.5% patients are under the
age group 2-14 years and least comes under the age group of 14-16 years.

Table 1: Description of patient according to age.

Age group No of patients % of patients

<12 months 38 31.6%
12-24 months 54 45%
2-14 years 21 17.5%
14-16 years 7 5.83 %

Distribution of patients according to severity of disease

In our study, we classified bronchopneumonia into three categories based on the disease severity as pneumonia, severe
pneumonia and very sever pneumonia. We observed that maximum number of patients (58.33%) admitted with severe pneumonia
followed by 25% of patients with very severe pneumonia and 16% of the total patients are suffering from milder form of pneumonia
as shown in the table 2.

Table 2: Distribution of patients according to severity of disease.

Disease severity No of patients % of patients

Pneumonia 20 16.66%
Severe pneumonia 70 58.33%
Very severe pneumonia 30 25%

Duration of hospital stay

In our study sample, most of the patients, 51 (42.4%) stayed in hospital for 6-8 days, 34 (28.33%) patents stayed for 9-12
days, 18 (15.1%) patients stayed for 3-5 days and 17 (14.16%) patients stayed for more than 12 days. Average duration of patient
staying in hospital ward was 8.71days. Hospital length of stay was shown in table 3.

Table3: duration of hospital stay.

Duration of hospital stay No of patients % of patients

3-5 days 18 15.1%
6-8 51 42.4%
9-12 34 28.33%
>12 17 14.16%

Monotherapy V/S combination therapy

Study revealed that out of 120 patients mostly,59 patients(49.16%) were on dual drug therapy, followed by 36(30%) patient
were on monotherapy, 25(20.83%) were on more than two drug combination therapy. Antibiotic use pattern was shown in table 4.
Graphical representation of Antibiotic use pattern shown in figure 2.

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Figure 2: monotherapy v/s combination therapy.

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Vol 6, Issue 09, 2016. Dr. Stimson Jose et al. ISSN NO: 2231-6876

Pattern of antibiotic prescribed

In our study we found that cephalosporins are the most commonly prescribed antibiotic for the management of
bronchopneumonia. 77.5% of the patients are prescribed with ceftriaxone followed by penicillins, beta lactamase inhibitors
(48.33%), glycopeptides (14.16%), Oxazolidinones (12.5%) respectively. Carbapenems are the least prescribed drug (3.33%). Details
are given in table4.

Table4: Pattern of antibiotic prescribed.

Antibiotics No of patients % of patients

Penicillin
Ampicillin 16 13.33%
Piperacillin 58 48.33%
lactamase inhibitors
Tazobactam 58 48.33%
Cephalosporin
Ceftriaxone 93 77.5%
Glycopeptide
Vancomycin 17 14.16%
Oxazolidinone
Linezolid 15 12.5%
Carbapenems
Meropenem 4 3.33%

DISCUSSION AND CONCLUSION

Inappropriate prescribing is a recognised worldwide problem of the health care delivery system [1]. In recent years, drug
utilization studies are found to be useful tool to facilitate rational use of drugs in health care delivery systems as it truly reflects the
status of health care system. In order to be rational, use of a drug must be effective, safe, prescribed for the proper therapeutic
indication and the correct dosage in an appropriate formulation, easily available and of a reasonable cost[6]. The present study
indicates the general trends of use of antibiotics in bronchopneumonia in paediatric inpatient department. This study aims to evaluate
and analyze the prescription pattern and provide them with feedback in order to stimulate thinking about their practice and thus to
improve their own performance. These studies should become a method of increasing job satisfaction and means of education for
health care professionals.
In our study Out of 120 samples enrolled in our study, 53.3% are males and 46.6% are females. In a similar study conducted
by Jhansi et al[7] shows that 51.0% were males and 48.9% were females. Similarly another study conducted by sruthi et al[8] shows
that 62.7% were males and 56 (37.3%) were females. These results are in concordance to the result obtained in our study.

Another study conducted by Jhansi et al[7] shows that 51.2% of patients are at the age less than one year and 29.5% of
patients are at age 1-3 years. Similarly kailash et al [9] states that 38.1% and 35.6% of the patients are at the age less than 1 year and
1-3 years respectively. These results are in concordance to the result obtained in our study. The incidence of bronchopneumonia is
more among paediatric patients of age less than one year.
In our study, 58.3% of patients were suffered from severe pneumonia and 25% were suffered from very severe pneumonia.
So the early diagnosis and management of pneumonia is necessary to avoid its complications.
A study by venkateshwara morthy etal[10] shows that maximum number of patients (55.2%) underwent 3 days of hospital
stay. But in our study majority (42.4%) underwent 6-8 days of hospital stay. The duration of hospital stay is strongly influenced by
disease severity.
Kailash et al [9] states that majority of patients underwent combination therapy which is in concordance with our study
results. In our study, 69.99% underwent combination therapy. Because of the emergence of antimicrobial resistance and decreased
sensitivity to antimicrobial agents, combination therapy is more effective than Monotherapy.
In our study, cephalosporins were the most commonly prescribed drug class. A similar study by divyaetal[11] shows that
majority of the patients are treated with cephalosporins. Another study conducted by Prasad etal[12] shows that beta lactams are the
most commonly prescribed antibiotic for pneumonia. Cephalosporins are the most commonly used antibiotic for the management of
pneumonia because of its broad spectrum of action and low risk of toxicity.
We also observed that majority of antibiotics are prescribed by IV route its may be because IV route is necessary for rapid
control of infections as compared to oral route. Majority of the drugs are prescribed in brand names. The possible reasons co uld be
prescribers perception about the formulations or the ease of availability and to recall for the prescriber and dispenser or may be
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because of the promotional strategies by pharmaceutical companies.

The present study provides an overall treatment pattern with antibiotics in Bronchopneumonia patients. Hence, in future
further researches should be conducted in large group of patients in order to compare the treatment methods and to analyze it and
modified if needed.
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Vol 6, Issue 09, 2016. Dr. Stimson Jose et al. ISSN NO: 2231-6876

ABBREVATIONS
UNICEF- United Nations International Children's Emergency Fund.
WHO-World Health Organization
MRP- Maximum Retail Price

CONFLICT OF INTEREST
There is no conflict of interest
Funding:
No funding sources
Ethical approval:
The study was approved by the institutional ethics committee.

REFERENCE
1. Harsh Mohan. Text book of pathology 3rd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2010. 471
2. Irena W B ,Anna B Respiratory Disease and Infection - A New Insight.2013[serial online] Available from:
URL:http://dx.doi.org/10.5772/54052
3. Raja Dhar. Pneumonia: Review of Guidelines Pneumonia in Children. JAPI. 2012; 60:25-8.
4. Narendera K A Rational Use of Antibiotics for Pneumonia. Indian Pediatrics. 2010; 17(47):11-8.
5. Adityaudupa, Pankajgupta. Antibiotic Therapy in Pneumonia:A Comparative Study of Oral Antibiotics in a Rural healthcare
centre. Int j pharm pharmsci. 2011;3(3): 156-58
6. Akhtar S, Vohora D, Pillai K, Dubey K, Roy M, Najmi A K et al. Drug Prescribing Practices In Paediatric Department Of A North
Indian University Teaching Hospital. Asian J Pharm Clin Res, 2012; 5(1): 146-149.
7. Jhansi M, kumar S V, Manigandan L, Vivean P.Patterns of Prescription and Drug Use in Paediatric Department of a Lower
Respiratory Tract Infection at a Teaching Hospital - A Preliminary Study. RJPBCS, 2015; 6(2): 1202-207.
8. Shruthi K V, Bhandare B, Adarsh E. Prescribing Pattern Of Drugs In Paediatric In-Patients With Lower Respiratory Tract
Infection At A Tertiary Care Hospital. WJPPS, 2016; 5(4) : 2396-2409.
9. Thapaliya K, Shrestha S, Bhattarai S,Basnet D, Chaudhary R K. Prescribing Pattern Of Antibiotics In Pediatric Hospital In
Chitwan District In Nepal. WJPPS, 2015; 4(11) : 1631-41.
10. Venkateswaramurthy N, Murali R, Kumar R S.The Study Of Drug Utilization Pattern In Pediatric Patients. Int J Pharm PharmSci,
2013; 5(3): 140-144.
11. Kancherla D, Sai M V S, Devi H J G, Sharma S.A Study On Prescribing Pattern Of Antibiotics In Respiratory Tract Infections In
A Tertiary Care Center. IJRSR, june 2015; 6(6): 4558-63.
12. Pandit P R, Kokanii V, Bhave K A. Prescribing pattern of antimicrobials used for treatment of acute respiratory tract infections in
children. IJRTST, February 2016; 18(1): 171-75.

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