Table of contents
Page Number
1. Acknowledgements 4
2. List of figures and tables 5
3. List of abbreviations 5
4. Abstract 6
5. Key words 6
6. Introduction & Review of literature 7-9
7. Aims and Objectives of study 10
8. Materials and Methods 11
9. Results 12-16
10. Discussion 17-18
11. Conclusion 19
12. Recommendations 20
13. References 21-23
14. Data collection form 24
1. Acknowledgements
I might want to express my profound and earnest appreciation to my research supervisor Dr. Mugahid Mobark who have been supporting me and giving precious direction all through this examination. His dynamism, vision, earnestness and inspiration have profoundly propelled me. I am grateful to all pharmacists in Al-Quwarah General Hospital who helped me to complete the data collection forms. Also I am especially indebted to all students in college of pharmacy in Al-Qassim University whom provided me with information about the graduation project.
2. List of tables :
No. of table Title of table Page No.
Table (1) Age and Gender distribution of the study population (n = 257) 12
Table (2) Age of the study population with the most antibiotic prescribed (n = 257) 14
3. List of figures :
No. of figure Title of figure Page No.
Figure (1) Diagnosis of patients among the study population (n = 257) 12
Figure (2) Subtypes of URTIs among the study population (n = 159) 13
Figure (3 ) Antibiotics prescribed among the study population (n = 257) 13
Figure (4) Antibiotics prescribed with the most prevalent diagnosis of patients among the study population (n = 257) 14
Figure (5) Comparison of the subtypes of URTIs with the common antibiotics prescribed among the study population (n = 159) 15
Figure (6) Other medications among the study population (n = 227) 15
Figure (7) Antibiotics prescribed with the most other medications among the study population (n = 227) 16
4. List of abbreviations :
SPSS = Statistical Package for the Social Sciences definition.
URTIs = Upper respiratory tract infections.
LRTIs = Lower respiratory tract infections.
UTI = Urinary tract infection.
M = month.
Y = years.
NSAID = Non-steroidal anti-inflammatory drugs.
5. Abstract
Background:
Antibiotics are well known drugs that are widely used in the treatment of bacterial infections. The development of antibiotics is probably the largest advance in medicine in the 20th century and has saved millions of lives worldwide from infections. Irrational uses of antibiotics have been associated with international appearance of antibiotic resistance. Antibiotics are not effective against infections caused by viruses, so if they are prescribed to a viral illness such as a cold, flu or a viral sore throat, they will have little or no role to play.
Aim of the study:
The aim of this study is to evaluate the prescribing patterns of antibiotic in Al-Quwarah General Hospital, to identify the most commonly prescribed antibiotics, to elicit the antibiotics’ prescription errors that might occur and to identify the most common type of diseases that were diagnosed.
Research Design and Methods:
Cross sectional retrospective study done in Al-Quwarah General Hospital in Al-Qassim region in Kingdom of Saudi Arabia from July to September 2017. A data collection form was used to collect 257 prescriptions. The data collected then analyzed using SPSS program.
Results:
The data collected showed that amoxiclav was the most antibiotic prescribed drug in 36.2% of cases followed by azithromycin and amoxicillin in 16.7% and 15.6% respectively. The most prevalent diagnosis was upper respiratory tract infection (61.87%) followed by gastroenteritis (7.0%) urinary tract infection (6.2%) tooth pain ( 4.7%) and the least was lower respiratory tract infection (4.3%). Regarding to other medications prescribed with antibiotics, acetaminophen was the common one (69.2%).
Conclusion:
The use of prescriptions of antibiotics are relatively high in Al-Quwarah hospital. Amoxiclav was the most prescribed antibiotic with URTIs which were the most prevalent diagnosis among the study. With availability of guidelines, the irrational uses of antibiotics can be avoided. As well follow of guidelines for antibiotic prescription and use of appropriate drugs for the disease can result in minimizing the unfavorable use of antibiotics.
Keywords: Antibiotics, prescribing, patterns and resistance.
6. Background and Review of literature
Antibiotics are depicted under antimicrobial medications which utilized for treatment and counteractive action of bacterial diseases. [1] They may repress or murder the microscopic organisms’ development. A fractional number of anti-infection agents additionally have antiprotozoal movement. [2] Antibiotics are not valuable against infections (the normal frosty or flu); drugs which hinder infections are named antiviral medications as opposed to anti-infection agents.
The key part of anti-microbials for the treatment of irresistible infections that are pervasive wherever in creating nations may not be denied. In any case, there are additionally reports of a silly utilization of anti-infection agents which may even prompt contaminations that are more regrettable than the initially analyzed ones. [3][4]
Antimicrobial-blends properties that were utilized as a part of medications for contaminations were portrayed more than 2000 years back. [5]
Later perceptions made in the research facility of antibiosis between microorganisms prompted the revelation of characteristic antibacterial created by microorganisms. Louis Pasteur watched “On the off chance that we could mediate in the opposition saw between a few microscopic organisms, it would offer maybe the best trusts in therapeutics”. [6]
In 1874, doctor Sir William Roberts watched that penicillium glaucum societies that is utilized as a part of the fabricate of a few sorts of blue cheddar did not indicate bacterial defilement. [7]
Antibiotics are utilized to treat or forestall bacterial diseases and there are diverse courses of organization for anti-toxin treatment. Anti-infection agents are by and large taken by mouth. In more extreme cases, for example, especially profound situated foundational diseases, are can be given intravenously or by injection.[1][8] Antibiotics likewise given topically for conjunctivitis and ear contaminations as eye drops and ear drops. Likewise can be utilized for skin conditions with skin break out and cellulitis. [9]
In 1928, Sir Alexander Fleming recognized penicillin, a particle delivered by specific shape that executes or stops the development of specific sorts of microscopic organisms. Fleming watched the spores of a green form (Penicillium chrysogenum) when he was dealing with a culture of sickness causing microbes in one of his way of life plates. He additionally watched that the nearness of the form murdered or kept the development of the microorganisms. [10]
Review of literature: “Antibiotic” alludes to substances created by microorganisms that demonstration against another microorganism. In this way, anti-toxins do exclude antimicrobial substances that are manufactured (sulfonamides and quinolones), or semisynthetic (methicillin and amoxicillin), or those which originate from plants (quercetin and alkaloids) or creatures (lysozyme). [11]
Antibiotics agents are the most much of the time recommended drugs among hospitalized patients; vast bit of anti-infection utilize seems, by all accounts, to be for viral or suddenly settling bacterial contaminations. [12]Doses of anti-infection agents can be given as oral , topical or infusions.
Classification of antibiotics: Diverse anti-infection agents have distinctive methods of activity, attributable to the idea of their structure and level of proclivity to certain objective destinations inside bacterial cells. [12]
1) Inhibitors of cell wall synthesis examples: penicllins, cephalosporins, bacitracin and vancomycin.
2) Inhibitors of cell membrane function examples: polymixin B and colistin.
3) Inhibitors of protein synthesis examples: Aminoglycosides, macrolides, lincosamides, streptogramins, chloramphenicol, tetracyclines.
4) Inhibitors of nucleic acid synthesis examples: quinolones, metronidazole, and rifampin.
5) Inhibitors of other metabolic processes example: both sulfonamides and trimethoprim disrupt the folic acid pathway.
Side effects of antibiotics: Inadvertently taking one additional measurements of your anti-toxin is probably not going to cause you any genuine mischief, yet it will expand your odds of encountering reactions. Contingent upon the sort of anti-infection utilized, it’s identified with unfavorable symptoms going from mellow to extremely serious. [13]
The regular symptoms incorporate looseness of the bowels and the unfavorable impacts run from fever and sickness to major hypersensitive responses, including photograph dermatitis and hypersensitivity. [14]
Antibiotic resistance: Utilizing Antibiotics agents can prompt protection. Each time you take it, touchy microorganisms are killed. Yet, safe germs might be left to develop and increase. They can spread to other individuals. They can likewise cause contaminations that specific anti-microbials can’t cure. Methicillin-safe Staphylococcus aureus (MRSA) is one case. It causes diseases that are impervious to a few basic antibiotics.[15]
Drug interaction: Anti-infection agents are noticeable among the gatherings of medications regularly endorsed. Numerous collaborations happen at the assimilation organize. Stomach settling agents and anti-diarrheal arrangements, specifically, can defer and diminish the retention of anti-infection agents, for example, antibiotic medications and clindamycin, by consolidating with them in the gastrointestinal tract to shape chelates or buildings. Different medications can influence gastric motility, which thusly frequently controls the rate at which anti-infection agents are retained. Some wide range anti-microbials can adjust the bacterial vegetation of the gut which might be identified with malabsorption states. The potentiating of harmful symptoms of one medication by another is a typical sort of connection. Anti-infection agents which are ensnared in this kind of cooperation are those which themselves have some lethality, for example, aminoglycosides, a few cephalosporins, antibiotic medications and colistin. The absolute most imperative unfriendly connections with anti-microbials are those which include different medications which have a low poisonous quality/adequacy proportion. These incorporate anticoagulants, for example, warfarin, anticonvulsants, for example, phenytoin and phenobarbitone and oral antidiabetic drugs like tolbutamide. Danger of connection emerges when the digestion of these medications is hindered by liver microsomal chemical inhibitors, for example, some sulphonamides and chloramphenicol, or is improved by protein inducers, for example, rifampicin. [16]
Antibiotics prescription: The high rate of antibiotics prescriptions is a big concern. Irrational use of antibiotics is a leading cause of antibiotic resistance and definitely increases the cost of treatment. Beside these it also increases the chance of drug-drug interactions and may lead to severe adverse drug reactions. The uses of the available bacteriological cultures and antibiotics sensitivity testing will greatly minimizes the irrational uses of antibiotics and significantly reduce the acquired costs. Antibiotic resistance is becoming a problem and approved guidelines for antibiotic use in hospital is an urgent concern. [17]
7. Aims and Objectives of study:
General objectives:
To evaluate the prescribing patterns of antibiotic in Al-Quwarah General Hospital that done during July, August and September 2017.
Specific objectives:
1) To identify the most commonly prescribed antibiotics
2) To elicit the antibiotics’ prescription errors that might occur
3) To identify the most common type of diseases that are diagnosed
8. Research Design and Methods
Type of Study:
Cross sectional retrospective study.
Study Area:
Al-Quwarah General Hospital in Qassim region in Kingdom of Saudi Arabia.
Study Population:
This study included patients that came to Al-Quwarah General Hospital outpatients and received antibiotics medications during July, August and September 2017.
Consent:
The Hospital administration agreed for me to collect the information from hospital records.
Data collection form:
The data collection form included patient demographics such as age, sex, diagnosis, drug details, dosage form, dose frequency and duration were recorded.
Sample size:
Patients attended Al-Quwarah General Hospital outpatient clinics and received antibiotics and it included 257 patients.
Inclusion criteria:
All patients attended Al-Quwarah General Hospital outpatient clinics and received antibiotics medications during July, August and September 2017.
Exclusion criteria:
1. Patients not received antibiotic treatment.
2. Patients with missing data.
Data analysis:
The data collected then analyzed using SPSS program.
9. Results:
Table (1) showed the age of the study population with the gender of patients. Patients were divided into five groups based on different age. The majority of patients were between 1 month and 15 years and the least were whose more than 63 years. The male patients were the common representing 57.59% of the total and the female patients were 42.41%.
Table (1) Age and Gender distribution of the study population (n = 257).
Table (1) Gender of the patients Total
Male Female
age of the patients: 1 month-15 y 64 49 113 (44%)
16 y – 31 y 58 24 82 (31.9%)
32 y – 47 y 18 21 39 (15.2%)
48 y – 63 y 4 9 13 (5.1%)
> 63 y 4 6 10 (3.9%)
Total 148 (57.59%) 109 (42.41%) 257 (100%)
(y, years) .
Figure (1) showed that the most prevalent diagnosis among the data collected was upper respiratory tract infection (URTIs) [61.87%] followed by gastroenteritis [7.0%] urinary tract infection(UTI) [6.2%] tooth pain [4.7%] lower respiratory tract infection(LRTIs) [4.3%] , while the least diagnosed were iron deficiency and hypothyroidism.
Figure (2) dominstrated that in 159 (61.87%) of patients with URTIs; the most common was acute tonsillitis (54.7%) followed by pharyngitis (25.8%) otitis media (10.69%) and common cold (8.1%).
Figure (3) showed that a total of 257 prescriptions were studied, out of which 218 (84.8%) prescriptions had mono antibiotics and 39 (15.2%) prescriptions had two antibiotics. The data collected showed that amoxiclav was the most antibiotic prescribed drug (36.2%) followed by azithromycin (16.7%) amoxicillin (15.6%) cefuroxime (10.12%) ciprofloxacin (8.95%).
Table (2) showed comparison between the age and the most commonly prescribed antibiotics. We observed that amoxiclav was the highest in all ages (36.2%) except in those older than 63 years it was not prescribed to them, however ciprofloxacin is prescribed to (40.0%) of those older than 63 years.
Table (2) Age of the study population with the most antibiotic prescribed (n = 257).
Table (2) The most antibiotic prescribed
amoxicillin azithromycin amoxiclav cefuroxime ciprofloxacin
age of the patients 1m-15 y 15.9% 20.4% 38.9% 16.8% 1.8%
16 y – 31 y 17.1% 15.9% 39.0% 2.4% 11.0%
32 y – 47 y 12.8% 10.3% 28.2% 10.3% 15.4%
48 y – 63 y 7.7% 15.4% 46.2% 0 15.4%
> 63 y 20.0% 10.0% 10.0% 40.0%
Total 15.6% 16.7% 36.2% 10.1% 8.9%
(p-value < .001) m= month & y= years.
Figure (4) showed that the most antibiotics prescribed with the most prevalent diagnosis. Amoxiclav and azithromycin were the most commonly prescribed antibiotics for URTIs while cefuroxime was the most commonly prescribed for gastroenteritis and ciprofloxacin was the most antibiotic prescribed for UTI.
(p-value < .001).
Figure (5) showed the comparison of the subtypes of URTIs in our study with the common antibiotics prescribed. Amoxiclav was the common antibiotic prescribed for acute tonsillitis and pharyngitis while ciprofloxacin was commonly used for otitis media and amoxicillin was commonly prescribed for common cold infection.
( p-value = .001).
Figure (6) showed a total of 257 prescriptions were studied in 227 (88.3%) of them other medication was prescribed. Acetaminophen in (69.2%) followed by NSAID (11.01%) and antihistamines (6.6%).
Figure (7) demonstrated comparison between the antibiotics and other medications presrcibed. It showed that amoxiclav was the most commonly prescribed antibiotic with acetaminophen and NSAIDs while amoxicillin was the most commonly prescribed with antihistamines.
(p-value < .001).
10. Discussion:
This study evaluated the prescription pattern of antibiotics in Al-Quwarah General Hospital. Data was collected from a total of 257 patients’ attended the outpatient clinic and received antibiotic prescription. The data was analyzed and the findings showed that the majority of patients were between 1 month and 15 years and the least were whose more than 63 years. The male patients were the common representing 57.59% and the female patients were 42.41%. These findings are similar with an international study conducted by Pramil Tiwari, Rajiv Ahlawat et al. 2014[18] The more antibiotic prescription at this age can be explained by that; the immunity at this age is not yet developed to many of the infectious agents that can cause infections. Oral route was the most common route of antibiotics administration and the most dosages form was syrup in 29.6% of patients and this is explained by that the majority of patients were between 1 month and 15 years. On the other hand findings revealed that the most prevalent diagnosis was URTIs in 61.87% of patients followed by gastroenteritis which represent 7.0% while UTI, tooth pain and LRTIs were found in 6.2%, 4.7% and 4.3% respectively while the least diagnosed was iron deficiency and hypothyroidism (figure 1). As compared these results with the previous studies conducted by Lita Susan Thomas et al. 2014[19], Maia De Luca et al. 2016[20] and Sumanth Gandra et al. 2017[21] they indicated that LRTIs were the most common indication for prescribing antibiotics. This inconsistency with these international studies is due to the most common age group in our study which was (1 month to 15 years) and the disease prevalence in this age group is commonly URTIs. This is supported by study done by Paulo M.C. Pitrez and Jos” L.B. Pitrez[22] which showed that URTIs are the most common causes of both morbidity and mortality in children. Other factors which may also explain the findings is the difference in the time period during which these studies were conducted and the season of our study as there is seasonal variation regarding the prevalence of some diseases. [23]
Amoxiclav was the most antibiotic prescribed drug in 36.2% followed by azithromycin 16.7% amoxicillin 15.6% cefuroxime 10.12% and ciprofloxacin 8.95% that showed in figure 3. Amoxiclav is a combination consisting of amoxicillin (”-lactam antibiotic) and potassium clavulanate (”-lactamase inhibitor). These results are consistent with a previous studies conducted by Maia De Luca et al. 2016[20], Aaron M. Harris et al. 2016[24] and Ghada Redha Al-Maliky et al. 2017[25] they indicated that the majority of the antibiotics prescribed were penicillins. As amoxiclav is a broad-spectrum antibiotics and more effective as empiric treatment for a variety of infections, explain its high prescription pattern. However a study done by Dr. Shivaleela et al. 2014[26] who indicated that the most commonly prescribed antibiotics were gentamicin (aminoglycoside). These differences is explained by that the prescription of antibiotics in their study was based on culture sensitivity testing unlike in our study which was empiric as it was done in outpatient clinic. In addition, amoxiclav was commonly prescribed for acute tonsillitis and dental infection while ciprofloxacin was commonly prescribed for UTI and otitis media, as well cefuroxime was the most commonly prescribed for gastroenteritis (figure 4 and figure 5). These findings go with a guideline published by M”decins Sans Fronti”res 2016[27] regarding indication of ciprofloxacin as a first-line for UTI and penicillins are the preferred antibiotics for pharyngitis (tonsillitis) and dental infection. However there is a difference in indicated amoxicillin as a first-line treatment for otitis media. In addition to that a guideline of Infectious Diseases Society of America (IDSA)[28] indicated ‘ceftriaxone ( 3rd generation of cephalosporin) is the first choice in shigella gastroenteritis’ while in our results was cefuroxime ( 2nd generation of cephalosporin). The choice of antibiotic mainly depends on which infection in the patient, however these differences may be due to variations in prescribing habits among different hospitals or among the different physicians.
We analyzed the comparison between the antibiotics and the other medications prescribed with it. Acetaminophen was the most commonly prescribed, representing 69.2% followed by NSAID 11.01% and antihistamines 6.6% (figure 6). This finding is justifiable as infections are recognized cause of fever and malaise. Acetaminophen is one of the safest antipyretic and rarely causes side effects. It is safe to use at the same time with antibiotics.
Drug related problems identified during the study revealed that in 8.18% of patients there was medication without indications as they have been prescribed antibiotics for common cold and as it’s a viral infections rather than bacterial infections, there is no indication of antibiotics.
A drug-drug interaction was found in prescription of ciprofloxacin with iron product (ferrous sulphate) which interferes with the absorption of ciprofloxacin into the bloodstream and reduces its effectiveness and the clinical pharmacist should counsel the patient to take iron product at least two hours before or four hours after ciprofloxacin dose to resolve this interaction.
11. Conclusion
The use of prescriptions of antibiotics are relatively high in Al-Quwarah general hospital. Amoxiclav was the most prescribed antibiotic with URTIs which were the most prevalent diagnosis among the study. Acetaminophen is the most common drug prescribed with antibiotics. High prescription rate of broad-spectrum antibiotics with prescription of antibiotics for common cold that were found in our study can increase the occurrence of bacterial resistance and moreover waste the resources. The uses of appropriate drugs for the disease and the follow of approved guidelines regarding antibiotic prescription in outpatient clinic will minimize the irrational uses of antibiotics.
12. Recommendations:
1. The outpatient clinic should follows and uses a guidelines for antibiotic prescription.
2. Highly recommended for the clinical pharmacist to counsel the patients about the possible drug-drug interaction
3. Increases the awareness of the antibiotic resistance that result from irrational uses of antibiotics.
13. References:
1. “Antibiotics”. NHS. 5 June 2014. Recovered 17 January 2015.
2. Chemical Analysis of Antibiotic Residues in Food. (PDF). John Wiley and Sons, Inc. 2012. pp. 1′ 60.
3. Principi N et al. Control of anti-infection treatment in pediatric patients. Formative pharmacology and therapeutics 1981; 2:145-55.
4. Schollenberg E and Albritton WL. Anti-infection abuse in a pediatric instructing clinic. Would med be able to Assoc J 1980;122:49-52.
5. Lindblad WJ (2008). “Contemplations for Determining if a Natural Product Is an Effective Wound-Healing Agent”. Global Journal of Lower Extremity Wounds. 7 (2): 75′ 81.
6. Kingston W (June 2008). “Irish commitments to the roots of anti-toxins”. Irish Journal of Medical Science. 177 (2): 87′ 92.
7. Foster, William; Raoult, Alain (December 1974). “History of Medicine: Early portrayals of antibiosis” (PDF). J R Coll Gen Pract. 24: 889′ 94. Recovered 31 January 2017. the primary logical perceptions of the opposing activities of different small scale living beings were made … by William Roberts of Manchester (1874) and John Tyndall of London (1876).
8. Antibiotics Simplified. Jones and Bartlett Publishers. 2011. pp. 15′ 17.
9. Pangilinan, Ronald; Tice, Alan; Tillotson, Glenn. “Topical anti-microbial treatment for uncomplicated skin and skin structure contaminations: audit of the writing”. Master Review of Anti-Infective Therapy. (1 October 2009) 7 (8): 957′ 965.
10. Tan, Siang Yong; Tatsumura, Yvonne (1 July 2015). “Alexander Fleming (1881′ 1955): Discoverer of penicillin”. Singapore Medical Journal. 56 (7): 366′ 367.
11. Antimicrobial protection learning webpage [Internet]. Michigan State University ; 2011 Available from: http://amrls.cvm.msu.edu/pharmacology/antimicrobials/antimicrobials-a presentation
12. Colgan, R., and P. Forces. Proper Antimicrobial Prescribing Approaches that Limit Antibiotic Resistance. American Family Physician 2001 , 64(6):999-1005.
13. Slama TG, Amin A, Brunton SA, et al. .”A clinician’s manual for the proper and exact utilization of anti-microbials: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria”. (July 2005) Am. J. Med. 118 Suppl 7A (7): 1S’ 6S.
14. “Antibiotics ‘ Side impacts”. NHS Choices. National Health Service (NHS), UK. 6 May 2014. Recovered 6 February 2016.
15. Antibiotic Resistance [Internet]. U.S. Division of Health and Human Services; 2015 [updated 6 September 2017] Available from: https://medlineplus.gov/antibioticresistance.html .
16. Bint AJ, Burtt I. Unfriendly anti-microbial medication associations . 1980 Jul;20(1):57-68.
17. Ravi Pathiyil Shankar, Praveen Partha et al. . Endorsing examples of anti-microbials and affectability examples of basic microorganisms in the Internal Medicine ward of a showing healing center in Western Nepal: an imminent report . 2003; 2: 7.
18. Pramil Tiwari, Rajiv Ahlawat et al. . Solution hone in patients of upper respiratory tract contamination at a pediatric outpatient center in Punjab . 2014 , DOI: 10.5530/ijopp.7.2.6.
19. Lita Susan Thomas , Selvaraj Lavanya, Murugaiyan Sudaroli , George Praveen Kumar. Recommending Patterns of Drugs in Outpatient Department of Pediatrics in Tertiary Care Hospital. Division of Pharmacy Practice, C.L.Baid Metha College of Pharmacy, Chennai. 2014 ; 128(6): 1053′ 61.
20. Maia De Luca1 , Daniele Don” , Carlotta Montagnani et al . Anti-toxin Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Information from the ARPEC Project. 2016 ; 11(5): e0154662.
21. Sumanth Gandra, Sanjeev K. Singh, Dasaratha R. Jinka et al . Point Prevalence Surveys of Antimicrobial Use among Hospitalized Children in Six Hospitals in India. 2017, 6, 19.
22. Paulo M.C. Pitrez, Jos” L.B. Pitrez . Intense upper respiratory tract diseases – outpatient conclusion and treatment . 2003;79 Suppl 1:S77-S86.
23. Feleke M, Yenet W, Lenjisa JL. Endorsing example of anti-microbials in pediatric wards of Bishoftu Hospital, East Ethiopia. Int J Basic Clin Pharmacol. 2013; 2 (6): 718’ 22.
24. Aaron M. Harris , Lauri A. Hicks , Amir Qaseem . Fitting Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention 2016;164(6):425-434.
25. Ghada Redha Al-Maliky, Mustafa Manhal Al-Ward, Aqila Taqi, Abdullah Balkhair, Ibrahim Al-Zakwani . Assessment of anti-infection recommending for grown-up inpatients at Sultan Qaboos University Hospital, Sultanate of Oman. 2017; 001146.
26. Dr. Shivaleela, Dr. K.Jagadeesh et al . A Study of Prescription Pattern of Antibiotics in Pediatric In-Patients of Mc-Gann Teaching Hospital Shivamogga Institute of Medical Sciences (SIMS), Shivamogga, Karnataka. 2014 , PP 67-71.
27. M”decins Sans Fronti”res. Clinical rules ‘ determination and treatment manual. 2016 version.
28. Andi L. Shane, MD1 Rajal K. Mody, et al. . Irresistible Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. IDSA rule . 2017 .
14. Data collection form
The prescribing patterns of antibiotics in Al-Quwarah General Hospital during July, August and September 2017.
1. No : ‘.
2. Age : ‘.
3. Gender :
‘ Male ‘
‘ Female ‘
4. Diagnosis : ‘.
5. Antibiotics prescribed :
Dose duration Dose frequency Dosage form Name of medication
6. Other medications :
Dose duration Dose frequency Dosage form Name of medication