Antibiotics prescription pattern in COVID-19 patients presenting in DHQ Teaching Hospital Sahiwal; Is Pakistan heading towards Post-COVID Antibiotic Resistance Era?
There is a lack of data about antibiotic prescription trends and patterns of inappropriate antibiotic stewardship in COVID-19 patient management.
To determine frequency and pattern of antibiotic prescription in COVID-19 patients presenting in DHQ teaching hospital, Sahiwal.
This observational cross-sectional prospective study was conducted from 1st June 2020 to 31st March 2021 in patients admitted in COVID isolation facility of DHQ Teaching hospital, Sahiwal with confirmed COVID-19 infection. Patients of all ages and of both genders were included. Data was collected by a pre-designed proforma. Data included patient’s age, gender, co-morbid conditions, type and duration of antibiotic use, and details of prescribing physicians. Descriptive statistics were applied to determine frequency and percentages of variables.
Out of 800 participants, 543(67.8%) were males, and the remaining 257 (32.1%) were females.
The majority 328(41%) of patients belonged to the age group 40-60 years. 639(79.8%) patients had co-morbidities. Diabetes mellitus was the most common co-morbid condition 248 (31%). Antibiotics were prescribed to all patients 800 (100%) before admission to the COVID Isolation facility. The majority of patients 348 (43.5%) had used antibiotics for 3-7 days before admission. Macrolides class was the most commonly prescribed antibiotic 417 (52.1%). General practitioners had more tendency to prescribe antibiotics 509(64%) as compared to medical specialists 212(26.5%) and pulmonologists79 (9.8%).
Antibiotic stewardship needs to be improved in COVID-19 patients and prescription should be evidence-based aided by laboratory tests. The development of local guidelines for judicious antibiotic prescription in COVID-19 will help in preventing antibiotic resistance.
Antibiotics, antibiotic resistance, COVID-19, drug prescription, SARS-cov-2
2. Quinn R. Rethinking antibiotic research and development: World War II and the penicillin collaborative. American journal of public health. 2013 Mar;103(3):426-34.
3. Neu HC. The crisis in antibiotic resistance. Science. 1992 Aug 21;257(5073):1064-73.
4. Levy SB. The challenge of antibiotic resistance. Scientific American. 1998 Mar 1;278(3):46-53.
5. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and therapeutics. 2015 Apr;40(4):277.
6. Levy SB, Marshall B. Antibacterial resistance worldwide: causes, challenges and responses. Nature medicine. 2004 Dec;10(12):S122-9.
7. Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, Spijker R, Hooft L, Emperador D, Dittrich S, Domen J. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID‐19 disease. Cochrane Database of Systematic Reviews. 2020(7).
8. Atif M, Asghar S, Mushtaq I, Malik I, Amin A, Babar ZU, Scahill S. What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan. Infection and drug resistance. 2019;12:687.
9. Gagliotti C, Buttazzi R, Ricchizzi E, Di Mario S, Tedeschi S, Moro ML. Community use of antibiotics during the COVID-19 lockdown. Infectious Diseases. 2021 Feb 1;53(2):142-4.
10. Hanif A, Ashar SM, Rabnawaz R, Yasmeen S. Self-medication of Antibiotics among the Students of Hamdard University, Pakistan. Journal of Public Health in Developing Countries. 2016 May 19;2(1):145-8.
11. Buetti N, Mazzuchelli T, Priore EL, Balmelli C, Llamas M, Pallanza M, Elzi L, Consonni V, Trimboli P, Forni-Ogna V, Bernasconi E. Early administered antibiotics do not impact mortality in critically ill patients with COVID-19. The Journal of Infection. 2020 Aug 1.
12. Lucien MA, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, Cerpa M, Joseph GA, Maki G, Zervos MJ, Dely P. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. International Journal of Infectious Diseases. 2021 Mar 1;104:250-4.
13. Lupia T, Scabini S, Pinna SM, Di Perri G, De Rosa FG, Corcione S. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. Journal of global antimicrobial resistance. 2020 Jun 1;21:22-7.
14. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020 Feb 15;395(10223):497-506.
15. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15;395(10223):507-13.
16. Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clinical infectious diseases. 2020 Jul 28;71(15):769-77.
17. Gjelstad S, Dalen I, Lindbæk M. GPs’ antibiotic prescription patterns for respiratory tract infections–still room for improvement. Scandinavian journal of primary health care. 2009 Jan 1;27(4):208-15.
18. Hanif A, Ashar SM, Rabnawaz R, Yasmeen S. Self-medication of Antibiotics among the Students of Hamdard University, Pakistan. Journal of Public Health in Developing Countries. 2016 May 19;2(1):145-8.
19. Shaikh BT. Anti-microbial resistance in Pakistan: a public health issue. Journal of Ayub Medical College Abbottabad. 2017 Apr 8;29(2):184-5.
20. Cao J, Tu WJ, Cheng W, Yu L, Liu YK, Hu X, Liu Q. Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China. Clinical Infectious Diseases. 2020 Jul 28;71(15):748-55.
21. Hasan R, Zafar A, Abbas Z, Mahraj V, Malik F, Zaidi A. Antibiotic resistance among Salmonella enterica serovars Typhi and Paratyphi A in Pakistan (2001-2006). The Journal of Infection in Developing Countries. 2008 Aug 1;2(04):289-94.
22. Jabeen K, Shakoor S, Malik F, Hasan R. Fluoroquinolone resistance in Mycobacterium tuberculosis isolates from Pakistan 2010–2014: Implications for disease control. International journal of mycobacteriology. 2015 Mar 1;4:47-8.
23. Rajper S, Khan E, Ahmad Z, Alam SM, Akbar A, Hasan R. Macrolide and fluoroquinolone resistance in Helicobacter pylori isolates: an experience at a tertiary care centre in Pakistan. Journal of Pakistan Medical Association. 2012;62(11):1140.
24. Sohail M, Khurshid M, Saleem HG, Javed H, Khan AA. Characteristics and antibiotic resistance of urinary tract pathogens isolated from Punjab, Pakistan. Jundishapur journal of microbiology. 2015 Jul;8(7).
25. Yamin M. Counting the cost of COVID-19. International Journal of Information Technology. 2020 Jun;12(2):311-7.
Copyright (c) 2021 Muhammad Waseem, Maryam Rafiq, Adeela Munir, Zahid Kamal, Nauman Aziz, Muhammad Junaid Iqbal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.