The study reveals that
the third generation class of cephalosporins (98.4% )were most commonly
prescribed, followed by second generation(1.1% ).This result is in agreement
with the results of various other studies that were reported.8,18,26Another
similar study conducted by Jonathan et al 23shows higher usage of
third-generation cephalosporin (95.85%), whereas a study conducted in a
teaching hospital in Nepal15 shows a low use of cephalosporins.
This extended use of third-generation cephalosporins may be due to its broad
spectrum of activity against most of the bacterial species, responsible for
causing infections, especially against gram-negative
microorganisms as well as the routine availability of these drugs in our setup.
They have been successfully used in controlling and treating infections. Their
rapid use in hospital settings to treat various infections has increased,
exerting a significant influence over the rates of multidrug-resistant
nosocomial pathogens.28 It was observed that ceftriaxone (93%) was
the most commonly prescribed antibiotic, due to its high anti-bacterial
potency, wide spectrum of activity and low potency of toxicity. 9, 10,
21 Similar results were obtained from various studies. 8,15,16.
Whereas, in a study conducted by Pereira et
al 17 shows the maximum use of ceftriaxone (66%) mainly
prescribed in surgery wards. But it was quite different from the results of a
study conducted by Kaliamoorthy et al 14
in a tertiary care teaching hospital, in which ceftriaxone was ranked
third in terms of utilization rate
(19.5%) following cefixime (32.7%) and cefotaxime (31.3%). The use
of cephalosporins was found to be high for the treatment of respiratory tract
infections (RTI’s).The findings were similar to results obtained from various
studies9,21,22

The present study
reveals that the mean duration of treatment with cephalosporins in the hospital
was found to be 4.87 days. The duration of antibiotics depends on the severity
of the infections. In general medicine, the mild-moderate conditions such as
UTI, typhoid, RTI’s requiring 1-7days of treatment duration. This signifies
that the treatment duration with cephalosporins was in accordance with the
hospital’s antibiotic policy. This finding was similar compared to the results
obtained from the study conducted by Reddy et
al 8 where the duration was 5 days.

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It was
observed that an average number of overall antibiotics and cephalosporins
prescribed per encounter was found to be 1.6 and 1 respectively. In our
hospital setting drugs were prescribed in their brand names instead of generic
names. The percentage of cephalosporins prescribed (63.7%), compared to other
antibiotics, was higher than the standard (20.0%-26.8%) derived to be ideal.22 This may promote
bacterial dissemination and resistance which suggests a need for regulation in
the prescribing practice of cephalosporin class of antibiotics. A high percentile of antibiotics prescribed in
this study may be due to patient’s expectation to receive antibiotics or the
prescriber’s belief that the therapeutic efficacy of antibiotic is low.
Parenteral antibiotics prescribed was found to be 68.8% out of which the
parenteral administration of cephalosporins was 88.6%.The results of this study
were high as compared to the standards recommended by WHO (13.4%-24.1%) due to
various reasons.22Firstly in our hospital setting, parenteral
cephalosporins are more preferably used as per antibiotic policy. Secondly, the
patients were usually discharged once the antibiotics were switched from
parenteral to oral therapy. The other possible reasons were, patient’s
unwillingness to stay in the hospital once the parenteral course of antibiotic
was completed or due to the myth amongst patients and physicians that parenterally
administered antibiotics show faster and increased efficacy compared to oral
forms. This will increase the cost as well as the risk of transmission of
potentially serious diseases through the unhygienic
use of injectable.

The use of
cephalosporins class of antibiotics has widely been assessed in the hospital by
measuring quantitative pharmacy data to calculate the number of DDD per number
of bed-days. 12 The ACI of cephalosporins in general medicine ward
was found to 4.95 DDD/100 bed-days of which, third-generation cephalosporins
were commonly used (4.88DDD/100 bed-days).The use of first and second
generation cephalosporins was low, and that of the third generation was higher
than that reported in Nepal study 15 Ceftriaxone was the most
commonly consumed (4.55 DDD/100 bed-days) parenteral cephalosporin and its
frequent use may lead to drug resistance.

The major
goal and challenge of antibiotic policies is the proper assessment and
evaluation of patient’s disease condition and rational prescribing pattern of
antibiotics by the physician, and proper medication adherence by the patients.
This approach would help prevent antibiotic microbial resistance, diminish cost
and improve quality of patient life and antibiotic usage.27 In our
study, 204 of the 370 patients’ charts (55.1 %) in the general medicine ward
were found to be complying for an overall evaluation of indication, dose, and
frequency of administration and duration of treatment according to the hospital
antibiotic policy. Majority (24.9 %) of the non-compliance to antibiotic policy
were related to differences in dose, route, frequency, and duration of
administration between practice and the guideline. Wrong uses of cephalosporins
in the assessments of acute gastroenteritis (AGE), rickettsial fever,
complicated UTI, viral conditions like cold and flu, Chronic Obstructive
Pulmonary Disease (COPD), and Bronchitis for which the guideline recommends no
indication of the drug was noticed in the study. The possible reasons for the
non-compliance in patients admitted for infections, including viral conditions
like cold and flu, and AGE, is the consideration of antibiotics for speedy
recovery leading to the lack of awareness and ignorance, exerting pressure on
physicians to empirically prescribe antibiotics. The non-compliance in the utilization of cephalosporins, if not in accord
with the hospital’s antibiotic policy, may prompt the rise of the bacterial
resistance which in turn compromises antibiotic effectiveness leading to treatment
failure, increased treatment cost as well as risk to the patient safety.