Abstract of Dissertation

Keyword : Antibiotics; Hospital Antibiotic Policy; Doctors Perception

Objective : i) To understand the hospital antibiotic policy for prescribing antibiotics ii) To assess the compliance of antibiotic prescription with hospital policy.iii) To understand and analyse the doctors perception with respect to antibiotic prescription.

Background : This study was carried out in Medanta- the medicity, Gurgaon. The hospital currently has around 960 beds operational and average monthly admission of 5000 out of which 50 -60 percent patients were on antibiotics and out of these around 8-10 percent patients were prescribed restricted group of antibiotics. This necessarily warrants a very efficient stewardship program and strict adherence to hospital’s antibiotic policy to ensure the appropriate use of antibiotics.

Methodology : Quantitative cross- sectional study was performed over the period of 2 months. Primary data was collected by HIS, patient’s file, hospital’s doctor’s dashboard and through doctor interviews.

Findings : The group of antimicrobials under consideration for this study is the restricted antimicrobials. A sample of 160 patients (both from IPD and ICU) and 50 doctors was taken. After analysis it was found that out of 160 patients, cultures were sent for 82percent (132) patients. Out of these 132 patients culture reports were available for 91percent (120) patients and out of these 120 only 52percent (62) prescriptions were in alignment with the culture sensitivity reports. analysis of data for doctors perception with respect to antibiotic prescription suggested that out of 50 doctors only 64percent doctors know about the hospital’s current antibiotic policy, only 20percent doctors always prefer to take opinion from microbiologists in case of doubts, 44percent doctors always prefer to send cultures to microbiology lab for identification of causative organism and 62 percent doctors always prefer to review their prescription once the culture sensitivity reports become available. Out of these 50 doctors 58percent doctors said they always takes patients age sex etc into consideration , 40percent doctors said they always considers patients past medical history while prescribing antibiotics. 22percent doctors said they never prescribe high end antibiotics for better clinical outcomes in shorter duration of time, 9percent said they never give antibiotics to their patients if they can rule out the presence of bacterial infection whereas 0percent doctors prefer to avoid antibiotics in case of suspected unclear diagnosis.

Recommendations : Compliance to antibiotic policy in ICU was more than IPD but the appropriate prescription of antibiotics comes out to be low in both areas and there is gap between doctors’ perception and practices they follow during antibiotic prescription. Further exploration required with respect to factors influencing doctors during antibiotic prescription.