作者：Beiranvand S， Mostafavi S， Tamimi M， Shahsavari S， Mohammadi H， Ghotbi N5 and Kalantar E
【摘要】 We report here the results of a prospective analysis of the pattern of antibiotics use over a one month period (May 2009) at two teaching hospitals in Sanandaj， western part of Iran.Data on antibiotic usage were obtained from the pharmacy services. Data was coded， computed and analyzed using SPSS version 11.5.A total of 1336 and 556 patients from Beasat and Tohid hospital respectively received antibiotic. Male patients represented 758 (41.5 %) and females 1080 (58.5 %) of the total number of patients evaluated by physicians at the two hospitals during the one month period.Usage of antibiotics varied from hospital to hospital; Beasat hospital had the highest usage. The wardwise distribution of antibiotic use showed that the prevalence of prescribing was highest in the post partum ward (66.58%). Similarly， among Tohid hospital wards， men surgical ward and women surgical ward prescribed antibiotics significantly more than all other wards.The route of administration of antibiotics was parentrally for 85.5% and 88.2% at Beasat anf Tohid hospitals respectively. The distribution of use of inpidual antibiotics showed that cepfzoline was the most frequently prescribed antibiotics used at both the hospitals.Delivery (childbirth) and pneumonia were the most frequent diagnosed pattern for which an antibiotic was prescribed at Beasat and Tohid hospital respectively.In conclusion our study suggests that there is considerable scope for improving prescribing pattern among the practitioners and minimizing the use of antibiotics. The improvement would be facilitated by providing feedback， prescriber education and hospital formulary.
【关键词】 Antibiotic prescription pattern， Cefazoline， Teaching hospital， Pneumonia， Sanandaj
INTRODUCTION
The study of prescribing patterns seeks to monitor， evaluate and suggest modifications in practitioners prescribing habits so as to make medical care rational and effective. Moreover， information about antibiotic use patterns is necessary for a constructive approach to problems that arise from the multiple antibiotics available［13］.
Analysis of indicationrelated drug prescription patterns is of particular interest with regard to rising costs of the health service. Widespread concern has been expressed about the inappropriate use of antimicrobials ［45］. Also inappropriate and irrational use of antibiotics can lead to microbial resistance to the commonly used antibiotics. This in turn can lead to the use of costlier， newer antibiotics to combat the problem of microbial resistance. This is an issue of great concern to a developed and developing country［68］.
The study of prescribing patterns is a component of medical inspection which seeks monitoring， evaluation and necessary modification in the prescribing patterns of prescribers to achieve rational and cost effective medical care［9］.
Antibiotic utilization substantially varies among different countries and even among health institutions within a country ［10］. In order to compare and discuss differences and structure of antibiotic utilization rationally， one has to express the utilization in internationally accept units.
We report here the results of a prospective analysis of the pattern of antibiotics use over a one month period (May 2009) at two teaching hospitals in Sanandaj， western part of Iran.
MATERIAlS AND METHODS
The study was conducted in May 2009 at the Beasat Hospital (320 beds)， and Tohid hospital (340 beds) which are affiliated to Kurdistan University of Medical Sciences， Sanandaj. Data on antibiotic usage were obtained from the pharmacy services. Data was coded， computed and analyzed using SPSS version 11.5. The institutional review board of the Kurdistan University of Medical Sciences approved the study.
RESULTS
Beiranvand S et al. Prescribing patterns of antibiotics at two teaching hospitals in Sanandaj A total of 2206 and 1684 patients from Beasat and Tohid hospitals respectively were included in this study. In which a total of 1336 and 556 patients from Beasat and Tohid hospital respectively received antibiotic. Male patients represented 450 (34.9%) and 308 (56.0 %) and females 838 (65.1%) 242 (44.0%) of the total number of patients evaluated by physicians at the two hospitals during the one month period (Table 1).Table 1 Patients characteristics admitted to the two hospitals（略）
Usage of antibiotics varied from hospital to hospital; Beasat hospital had the highest usage. The wardwise distribution of antibiotic use at Beasat hospital (Table 2) showed that the prevalence of prescribing was highest in the post partum ward (66.58%). Similarly， among Tohid hospital wards， men surgical ward and women surgical ward prescribed antibiotics significantly more than all other wards.The route of administration of antibiotics was parentrally for 85.5% and 88.2% at Beasat anf Tohid hospitals respectively (Table 3). Table 2 Ward wise categorization of prescriptions at the two hospitals（略）Table 3 Prescribing frequency of the most commonly prescribed antibiotics in hospitals（略）
The distribution of use of inpidual antibiotics (Table 4) showed that cephazoline was the most frequently prescribed antibiotics used at both the hospitals.Delivery (childbirth) and pneumonia were the most frequent diagnosed pattern for which an antibiotic was prescribed at Beasat and Tohid hospital respectively (Table 5). Table 4 Route of antibiotic administration at the two hospitals（略）Table 5 Five most diagnosis pattern at the two hospitals（略）
DISCCSSION
The major prescribing irrationalities could be revealed after analysis of utilization of antibiotics and prescribing pattern of drugs reflects the clinical judgment of the clinicians.
The present study revealed that 48.63% of the patients were prescribed an antibiotic which is relatively higher than those in other reports. (1213). Cefazolin was the most frequently used antibiotic， accounting for over 46.1 % and 40.6 % of prescriptions at Beasat and Tohid hospital respectively (Table 5). A study done in Spain showed extensive inappropriate third generation cephalosporine utilization (14). Lesser utilization of antibiotics is a positive sign as polypharmacy is known to be a contributing factor for hospitalizations. It may also lead to drug interactions， adverse drug reactions patient and antibiotic resistance (3，15).
In our study， at Beasat and Tohid hospital 66.58% and 75.18% of prescriptions were from the post partum ward and men surgical ward respectively which is similar to other report (16). Studying the antimicrobial prescribing pattern in an Indian hospital has showed that antimicrobials prescription was maximum in surgery， urology and internal medicine departments and Amikacin， ciprofloxacin， cefotaxime and cloxacillin were the most preferred drug (17).
In many studies the most commonly diagnosed pattern was respiratory tract infection and urinary tract infection followed by sepsis and intraabdominal infections (18， 3); similarly， in our study delivery (childbirth) and pneumonia was the most frequent diagnosed pattern for which an antibiotic was prescribed at Beasat and Tohid hospital. The excessive use of injectable is common in many developing countries. In this study 85.5 and 88.2 percent of the patients at Beasat and Tohid hospital were prescribed antibiotics by the parenteral route respectively. In a study reported from Kathmandu (19) 75% of antibiotics were prescribed by the parenteral route. Decreasing the prescribing of parenteral antibiotics and an early switch to oral antibiotics will significantly reduce the expenditure incurred.
CONCLUSION
Our results indicate that there is considerable scope for improving prescribing pattern among the practitioners and minimizing the use of antibiotics. The improvement would be facilitated by providing feedback， prescriber education and hospital formulary. The Drug and Therapeutics Committee of the hospital should take the leading role in rationalizing the prescribing and dispensing pattern in the hospital.
LIMIATAIONS
The study was conducted during the period of one month (May 2009) and thus the seasonal variation was not evaluated. The selection of prescriptions from different wards may not be representative of the patient population attending the OPDs of the hospital.
ACKNOWLEDGEMENT
We are grateful to Vicechancellor in Research Affairs for the financial support.
参考文献
1 Srishyla M， Naga R， Venkataraman B. Drug utilization of antimicrobials in the inpatient setting of a tertiary hospital. Indian J Pharmacol. 1994; 26:282287.
2 Nicole Huang， YiingJenq Chou， HongJen Chang， Monto Ho and Laura Morlock. Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis， URIs， and acute bronchitis in Taiwan: a multilevel modeling approach. Family Practice 2005; 22(2):160167.
3 Ravi S， Praveen Pa， Nagesh K， Joshy E， Kottallur B. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study. Ann Clin Microbiol Antimicrob. 2003;2(7):19.
4 Miljkovic M， Dukic L. Analysis of drug utilization in Serbia during 1996 1997. Pharmacoepidemilogy. 2000; 9:5964.
5 Srishyla M， Naga Rani M， Venkataraman B. Drug utilization of antimicrobials in the inpatient setting of a tertiary hospital. Indian Journal of Pharmacology 1994; 26:282287.
6 Alam K， Mishra P， Prabhu M， Shankar PR， Palaian S， Bhandari RB， Bista D. A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal. Kathmandu University Medical Journal. 2006; 4( 4):436443.
7 Sunarto G， Suryawati S，Impact evaluation of self monitoring of drug use Indicators in health facilities， Thailand ICIUM 2004.
8 Kunin CM. Resistance to antimicrobial drugsa worldwide calamity. Ann Intern Med 1993; 118:557561.
9 Drug use surveys and interventions conducted in WHO regions: 19932002. 2003; 33:177.
10 Bergman U， Christenson I， Jansson B， Wiholm BD. Auditing hospital drug utilization by means of defined daily doses per bedday. A methological study. Eur J Clin Pharmacol 1980; 17:1837.
11 Van der Meer . and Gyssens I. Quality of antimicrobial drug prescription in hospital. Clin. Microbiol. Infect. 2001: 7:1215.
12 Teferra Abula， Mohammed Kedir. The pattern of antibiotic usage in surgical inpatients of a teaching hospital， northwest Ethiopia. Ethiop.J.Health Dev. 2004;18(1):3538.
13 Goossens H， Ferech M， van der Stichele R， Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a crossnational database study. Lancet. 2005; 365:57987.
14 Pinto Pereira LM， Phillips M， Ramlal H， Teemul K， Prabhakar P. Third generation cephalosporin use in a tertiary hospital in Port of Spain， Trinidad: need for antibiotic policy. BMC Infect Dis. 2004;4(1):59.
15 Van der Meer， JW; Gyssens， IC. Quality of antimicrobial drug prescription in hospital. Clin Microbiol Infect. 2001;Suppl 7:1215.
16 Prescribing patterns of antibiotics and sensitivity pattern of common microorganisms in the internal medicine ward of a teaching hospital in western Nepal. Annals of Clin Microbiol Antimicrobi. 2003:3(7); 29.
17 Sharma D， Reeta K， Badyl DK， Garg SK， Bhargava VK. Antimicrobial prescribing pattern in an Indian tertiary hospital. Indian J Physiol Pharmacol， 1998: 42(4):533537.
18 A retrospective review of the frequency and infections pattern of antibiotic utilization on a Palliative Care Unit. J of Symptoms Managements. 2009; 16(7):347381.
19 Palikhe， N. Prescribing Pattern of Antibiotics in Paediatric Hospital of Kathmandu Valley. Kathmandu University Medical Journal. 2004; 2(1):612.