A study on prescribing patterns of antimicrobials in diabetic foot ulcer in a tertiary care hospital

Abstract

Background: Diabetic foot ulcers (DFUs) are one of the most feared complications of Diabetes Mellitus (DM), which often become infected leading to complications like osteomyelitis, amputations and septicemia. There are scanty reports of data regarding the patterns and the cost analysis of antibacterial therapy to treat DFUs.Objectives: To study the prescribing pattern, approval status, inclusion in World Health Organization (WHO) essential medicines list/National List of Essential Medicines (NLEM) and rationality of antibacterials prescribed in the management of DFUs.Methods: Data was collected from records of 52 inpatients with a diagnosis of DFU from Saraswati Medical College, Unnao, U.P., India. The prescribing patterns, approval status, cost and listing of antibacterials in WHO essential medicines list/ NLEM were analysed. The data was presented as percentages, mean and standard deviations.Results: Among the 13 positive culture data, 10(77%) were gram negative in nature. Of the 155 antibacterial prescriptions analysed, single drug formulations were most commonly prescribed [109 (70.32%)]; 144 (92.90%) were approved by Drug Controller General of India (DCGI) and 135 (87.10%) by United States Food and Drug Administration (USFDA); 101 (65.16%) antibacterials were included in both WHO and NLEM; parenteral formulations were the commonly used dosage forms [97 (62.58%)]. The most common class of antibacterials prescribed were beta-lactams [Anatomical Therapeutic Chemical (ATC) class: J01C and J01D], both before and after culture and sensitivity (C/S) testing [79(63.2%) and 15(50%) respectively]. Only 16 (10.32%) drugs were prescribed by their generic names. The average cost per dose and the total cost during hospital stay for quinolones were Rs. 7.24, Rs. 92.95 and Rs. 416.97, Rs. 5539.06 for β-Lactams respectively.Conclusion: Gram negative organisms were most commonly isolated. Parenteral formulations were preferred over oral formulations and single drug formulations over fixed dose combinations (FDCS) in the management of DFUs. Beta-lactams comprised the major class of antibacterials prescribed before and after C/S testing. More than 80% of the antibacterials prescribed were approved by DCGI and USFDA and almost 60% were included in the WHO essential medicines list and NLEM. The average cost per dose and the total cost during hospital stay were highest for β-lactam antibacterials and least for quinolones.

Key words: Prescribing patterns; Antibacterials; Diabetic foot ulcer