Pattern of Antimicrobial Drug Usage among Inpatients of a Government Medical College Hospital in Kerala, India: A Cross-sectional Study

Introduction: Antimicrobial Resistance (AMR) has become a global emergency threatening to once again make infectious diseases the number one killer of mankind. Antimicrobial Stewardship (AMS) programs require baseline antimicrobial use and microbial drug resistance patterns to formulate rational antimicrobial use policies. However, information about the pattern of antimicrobial drug use among inpatients of government medical colleges in Kerala is scarce. Aim: To describe the antimicrobial use pattern among inpatients of a government medical College Hospital in Kerala. Materials and Methods: A medical-record-based crosssectional study of antimicrobial use among inpatients admitted to Government Medical College Hospital, Alappuzha, Kerala, India was conducted on a single calendar day (16th January 2019). Data was collected in a structured case record form and expressed as counts (%) or median (25th percentile, 75th percentile). Summary statistics were prepared using Microsoft Excel® spreadsheets. Results: Among 210 (107 female) inpatients admitted on 16th January 2019, 137 (65.2%) received at least one empiric antimicrobial despite being indicated in 118 (56.2%) only. Among inpatients prescribed antimicrobials, each received a median of 1 drug for treatment over a median of 3 (0,8) days of therapy. A total of 55 (40%) of antimicrobial use was for surgical prophylaxis in different specialties, but for much longer than recommended by guidelines. Details of culture and sensitivity tests were available in only 10 (4.3%) inpatient records, precluding any change in empiric to definitive antimicrobial therapy in virtually all cases. Third-generation cephalosporins, belonging to the watch group of World Health Organisation (WHO) Access, Watch and Reserve (AWaRe) classification, were the most widely used class of antimicrobials. Topical moxifloxacin was the most common antimicrobial prescribed for ocular disorders. Antimicrobial use from the access category was achieved in roughly 50% of cases, which was much below the target of 60% set by WHO for the period of 2019-23. Conclusion: The present study found unindicated use as well as prophylactic overuse of antimicrobials, especially from the WHO watch category of drugs, among inpatients at a Medical College Hospital. Defensive clinical practice and lack of faith in infection control systems may be contributing factors to this phenomenon. Regular, prospective and collaborative monitoring of antimicrobial use patterns in all tertiary care hospitals may help in strengthening AMS and combating AMR.